Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

MONDAY, JUNE 29, 1992

Volume 5, Number 9

[ Page 3207 ]

The House met at 2:05 p.m.

B. Copping: I'm very pleased to introduce a group of visitors: my aunt Beth Fitzgerald from Burnaby; extended-family members Bill and Margaret McKnight from Scarborough, Ontario; and Marion Miller from Scotland. Would the House please make them welcome.

Hon. L. Boone: It is my pleasure to introduce three visitors seated in the members' gallery this afternoon. With us is the High Commissioner of Australia, His Excellency David Spencer, accompanied by his wife and the Australian consul in Vancouver, Mr.John Newell. Would members of the House please join me in welcoming up over our visitors from down under. Welcome to B.C.

F. Gingell: I just happened to see my eye doctor in the gallery, Dr. Bayne, and Mrs. Bayne. I presume that he's here because I don't have time to go in for my examination, which I believe is overdue. Please make them welcome.

D. Schreck: In the gallery this afternoon are my wife, Angie Burgess, and, visiting from Minneapolis, Minnesota, my brother and his wife, Lee and Debbie Schreck. For the benefit of some members of the House, we might say that we came from the same puppy farm. Would the House please join me in making them welcome.

Oral Questions

AIR AMBULANCE CONTRACTS

W. Hurd: A question to the Minister of Government Services. On June 22 the minister offered a guarantee that Carson Air would be up and running by June 26 in Kelowna and Prince George. Can the minister confirm that in fact this has happened and that the Southern Interior Flight Centre continued their ambulance service throughout the weekend and are still flying Medivacs as of this minute?

Hon. L. Boone: As I just got back from a beautiful weekend in sunny Prince George, I'm going to have to take that question on notice and get back with that information for the member.

GAMING REGULATIONS

J. Weisgerber: According to the B.C. Gaming Commission, casinos in British Columbia are allowed to advertise their location and hours of operation, but they are specifically forbidden from advertising any inducements to gamble. Can the Attorney General confirm that this is the case? Can he confirm, as well, that to the best of his knowledge the gaming industry in British Columbia supports these regulations?

Hon. C. Gabelmann: Knowing how this place works, I'm going to take the question on notice and ask the member if he would be kind enough to help me by providing the additional information later so that I can return to the House with a full and complete answer.

The Speaker: The hon. member has a new question?

J. Weisgerber: Knowing how this place works too, I will start off with a new question.

Given that the existing policy in British Columbia forbids local charities from advertising their casinos, can the minister advise whether he believes it's appropriate, if not illegal, for casinos in the United States to advertise in British Columbia and induce cross-border gambling? In particular, the Lummi Indian reservation has been advertising in the Sun offering free dinners, chances to win a car and that kind of thing. Does the Attorney General support that? Does he believe it falls within the law?

The Speaker: Is the hon. member asking for a legal opinion of the Attorney General? I only want to clarify your question.

J. Weisgerber: Hon. Speaker, knowing not only how this place works but the background of the Attorney General, it would be foolish of me to seek a legal opinion from him when there are so many others available. But given that the Attorney does speak on behalf of the government, I was asking for the position of the government on this issue.

Hon. C. Gabelmann: I think the member's question had a double-barrelled element to it. Part of it was asking for a legal opinion, which, of course, even if I were well trained in the matter, I would not provide in this forum.

As far as the issue goes, it's not just casino operations immediately south of the border that are advertising; some as far away as Nevada advertise too. It raises a number of interesting questions. The whole issue of gambling, including casino gambling, is under review by the government, in all of its elements. I would prefer to be able to come back and try to give the member specific answers to some of the questions he's asking, but most of the answers to these questions will come out by way of public policy announcements following the complete review.

The Speaker: Final supplemental, hon. member.

J. Weisgerber: The Attorney General might be aware that the Lummi casino indicates that it gathers about $1 million a week from British Columbia in gambling activity. That money is being denied to local charities and non-profit organizations. Would the Attorney General undertake to ensure that, as far as advertising in British Columbia is concerned, domestic charities are not disadvantaged by being denied the opportunity to advertise what organizations from the United States are allowed to?

[ Page 3208 ]

Hon. C. Gabelmann: I'm not prepared to give that assurance at this stage, pending our full review.

LUMBER EXPORTS

C. Tanner: I have a question to the Minister of Economic Development, Small Business and Trade regarding the charge by the IWA that rough lumber and B.C. jobs are being shipped south by Terminal Forest Products in Richmond. Is the minister aware of how many B.C. remanufacturing firms have relocated in the U.S. border areas in the past year and how many Canadian jobs are being affected?

Hon. D. Zirnhelt: Since I don't recall the exact number, I'm happy to take the question on notice and provide a full answer.

The Speaker: A new question, hon. member.

C. Tanner: My supplementary question is to the same minister. Since this company is using the public's resources to do business in the province, does the minister accept the proposition that remanufacturing lumber lines that rely on B.C. logs should close and then reopen in Washington State? What about B.C. workers and their families, Mr. Minister?

Hon. D. Zirnhelt: I would have to check the facts of the allegations that they are taking semi-processed material across the border. There are no stops on the borders for semi-processed material. We export a lot of rough lumber.

C. Tanner: I have a supplementary question for the same minister. Has the minister held any formal meetings with the lumber remanufacturing sector of the lower mainland, and have they advised this minister why they are shipping rough B.C. lumber to Washington State for processing?

Hon. D. Zirnhelt: The answer to your question is yes. As you know, value-added industry is very dear to our hearts and very important. It's the way of the future. But it is extremely difficult, and we are putting considerable resources into that. I have to remind you that the standing committee of this Legislature is reviewing the supply of timber to the remanners in the province.

[2:15]

POLLUTION CONTROL

A. Warnke: My question is for the Minister of Environment, and it concerns the recent court decision to dismiss charges against Northwood Pulp and Timber. Since the Crown was criticized for bringing the charge when the company was trying to find a solution -- and indeed the court has even called the ministry's actions unfair and oppressive -- and this especially at a time when there was a pilot project with the full knowledge of the Environment ministry, has the ministry learned a lesson from this case, that when a company seeks help it should respond instead of trying to bring forth a charge that is bound to fail in the courts?

Hon. J. Cashore: It's incumbent on the Ministry of Environment to take those actions necessary to send out a very important message to the public that we're serious about curtailing pollution. At the same time, it's incumbent on all of us to learn from experiences day by day.

A. Warnke: In light of the answer that was provided by the Environment minister, and given the results of this case, will the minister be instructing his ministry to change this policy and work more constructively with industry?

Hon. J. Cashore: The ministry is continuing to work constructively with industry. With regard to the enforcement program, I would point out that if we were to compare the total amount of fines collected in 1987, it was averaging around $35,000 a year for the entire province. Now we're looking at an amount that is well over a $1 million, but still not good enough. We have to improve our enforcement, we have to improve our record on enforcement and we have to improve our ability to send a very clear signal to polluters that this will not be tolerated. However, those are costly dollars -- the ones that come through monitoring and enforcement -- and therefore we are embarked upon an array of methods that will deal with curtailing pollution.

A. Warnke: It's interesting that when one loses a case like that you can still put a positive spin on it, but nonetheless there's a nice try.

To the Minister of Forests, on a final supplementary: was the minister at any point made aware of the situation, and did the minister talk with the Minister of Environment in an attempt to avoid an unfair, oppressive legal action?

Hon. D. Miller: Hon. Speaker, I know nothing about unfair or illegal actions. The Ministry of Environment has regulations. I don't suppose the member is suggesting that we do not enforce those regulations. What he appears to be suggesting I find very troublesome. If a certain industry is exceeding the regulations established by government, it appears to me that government and people in the ministry have a responsibility to take appropriate action. If it's subsequently deemed by the court that there are mitigating factors, then that often happens. I hope the member is not suggesting that officials do not enforce the regulations we have in this province.

LABOUR DISPUTES

D. Mitchell: Hon. Speaker, I have a question for the Minister of Economic Develpment, Small Business and Trade. Now that mediator Vince Ready has booked out of the pulp industry dispute, sawmills are becoming idle throughout the province, and unfortunately this dispute threatens to be a long one. I'm wondering if 

[ Page 3209 ]

the minister or his ministry is doing anything to measure the impact of this dispute on the province's reputation as a reliable supplier of forest products.

Hon. D. Zirnhelt: The easy answer is that we constantly monitor changes in the economy, along with the Ministry of Finance and any other ministry that has something to do with it. The suggestion that we don't understand what's going on is the kind of comment that doesn't really add to the debate.

The answer to your question is that we do measure the impact. We're not happy that we have a dispute, and the Minister of Labour will do everything in his power to get the parties to come to an agreement.

D. Mitchell: A supplementary question to the minister. We've been advised that we have now lost more person-days to strikes and labour disputes so far in 1992 than in any year since 1986. Can the minister tell us what steps his ministry is taking to assure our trading partners throughout the world that, despite this dismal labour relations record in our province, we still are a place to invest in for business, and we are still a reliable trading partner?

Hon. D. Zirnhelt: You know, this is the first pulp dispute in many years. We haven't done anything to contribute to the unrest in the pulp industry. With respect to what we tell people overseas, we tell them that we're working to establish labour laws in the province that are fair to business and labour, and that we will have the most modern labour laws in the world.

The Speaker: Final supplemental, hon. member.

D. Mitchell: My final supplementary is to the Minister of Finance. We have reports that the current pulp industry dispute is causing a reduction in provincial revenues in the order of $1 million per day -- that's what reports in the media have suggested. Given that fact, I wonder if the minister could tell me whether the pulp strike, which appears to be headed for a long haul, unfortunately.... Is his ministry prepared to begin an immediate review of its revenue projections for this fiscal year?

Hon. G. Clark: If we were to take advice from the Liberal Party, we'd be spending more money in every area of government. Every day they stand up here and ask us to spend more money. They now want to give more money to doctors. They stand here every day and mouth the BCMA executive's line for the government of the day to spend $50 million or $60 million -- and that would affect our revenue projections and expenditure projections. We are looking for a responsible opposition that's concerned about the public interest, not about the narrow interest of people like the B.C. Medical Association executive, an opposition that does not come in here with silly excuses like the pulp mill question. For us to review our revenue and expenditure.... I want to advise the House that every month the Ministry of Finance does a review of revenue and expenditure. Thank goodness we don't pay any attention to what the Liberal Party says; otherwise we'd be in deep financial trouble in this province.

UNEMPLOYMENT AMONG YOUTH

L. Reid: My question is to the Minister of Economic Development, Small Business and Trade. Unemployment rates among our young people are up 12 percent over last year. What is this government's economic strategy to keep British Columbia's young people working?

The Speaker: Minister, the Chair recognizes it's a very broad question. I would ask the minister to answer briefly, if possible.

Hon. D. Zirnhelt: When I spoke on the economic strategy of the province during the estimates, it took 20 minutes. Perhaps I could supply you with a full written answer, and you can read it at your leisure.

Hon. A. Edwards tabled the 1991 annual report of the British Columbia Utilities Commission; the 1990 annual report of the British Columbia Utilities Commission; the 1990-91 annual report of the ministry; and the 1990-91 annual report of the British Columbia Petroleum Corporation. Presenting Reports

F. Gingell: Today I have the honour to present the first report of the Select Standing Committee on Public Accounts. I move that the report be taken as read and received.

Motion approved.

F. Gingell: I ask leave of the House to permit the moving of a motion to adopt the report.

Leave granted.

F. Gingell: I move that the report be adopted.

I am really pleased to present this. I understand that in recent history no other Public Accounts Committee report has contained such extensive recommendations. The committee has truly worked with a great deal of harmony. I also wish to note that three members of the committee get gold stars for perfect attendance. The auditor general and the comptroller general have worked very well together to resolve issues of concern to our committee.

There is much more work to be done. We need time. We also need more authority. We need to be allowed to sit intersessionally and during any sitting of the House. That truly would make the work of the committee easier. We also should have the permission of the House for the committee to make on-site visits.

We look forward to the Crown corporations being examined by the Crown Corporations Committee. Our committee will watch that process with interest, and we look forward to receiving -- very shortly, we hope -- the auditor general's annual report.

[ Page 3210 ]

Motion approved.

Hon. G. Clark tabled the 1991-1992 annual report and financial statements of the British Columbia Transit Corporation.

Ministerial Statement

TOURISM STUDY

Hon. D. Marzari: During the estimates debate of the Ministry of Tourism and Ministry Responsible for Culture, I mentioned the necessity of building and improving on our research capacity. While the momentum of the industry itself increases the visibility and credibility of tourism, evaluation and monitoring techniques must be developed and refocused accordingly.

We have embarked upon a program that will help us clarify in Tourism the needs and goals with a research base. Today I am tabling a commissioned report entitled Tourism: The Professional Challenge. It reveals that we can expect an additional 60,000 jobs in British Columbia's tourism industry by the year 2001. It describes the types of jobs which will be created and the training programs facing the system. In 1990 there were approximately 181,600 people working in tourism-related sectors, the largest being in food and beverage, representing 40 percent of the total. An addition of 60,000 people to that workforce within the next decade means a growth rate of 2.6 percent, or about one and a half times the general employment growth rate.

I want to give all members an opportunity to reflect upon the implications. Naturally, there are direct implications for the tourism industry. If well-trained individuals are not available to meet the needs of our visitors, our reputation as a destination could be in jeopardy.

This report spells out implications for our labour force, our training institutions -- those existing and those which should be created -- and the general economy of this province. You will be interested that the report's first suggestion, at the top of the list, is for a change in public attitudes about the economic benefits and employment potential of British Columbia's tourism industry. That's where we come in. As members of the Legislature, we can help empower individuals and organizations to realize the full potential of a tourism workforce. The industry will come of age only when its employees sense that there is a future in tourism and are a part of a well-paid professional workforce and recognized as such by the community at large.

I would like to acknowledge the fine work of the Ministry of Advanced Education, Training and Technology for its major contribution to the study. The authors were supervised by the Pacific Rim Institute of Tourism, an agency which works closely with the ministry. Acknowledgements would be incomplete if Employment and Immigration Canada were not mentioned and thanked for its funding as well.

I know all members will find in this document keys to the directions and challenges facing this province's fastest-growing industry.

[2:30]

C. Tanner: I would like to thank the minister for her report, assure her that we'll be following very closely what the report contains and tell her that we're a little disappointed in that 60,000 jobs aren't enough in the next eight years. We expect better than that. A growth rate of 2.5 percent is not what we expect in the tourist industry. We will make suggestions this time next year which will better that figure by quite a long way. Finally, we commend to the minister her very close association with those tourist associations that are out there, encouraging them to employ even more people in our industry, which will make us and the province rich.

L. Hanson: I look forward to an opportunity to read that report with great interest.

The minister suggested that there was some change in attitude needed by the tourism industry as well as the people of British Columbia towards the tourism industry. I think it has long been a fact, and I would question the minister's statement to that effect, because the people of British Columbia well recognize the tourist industry -- what it does contribute to our economy and how important it is to encourage and, in fact, assist through government programs.

I look forward to reading that report. I hope that the Ministry of Tourism will be able to, again, support the tourism industry in the way that it has in the past; rather than reducing the budget, they will hopefully bring it back to a level that will show the British Columbia government's enthusiasm about the tourism industry in British Columbia.

B. Jones: I ask leave to make an introduction.

Leave granted.

B. Jones: I had the privilege the other day of welcoming to this country and this province a group of opticians who are attending the international guild conference in Vancouver. Visiting us today are 40 persons from that delegation -- opticians, spouses and their children -- and I'd like to read the names, with your indulgence, of some of the members in the party. From Canada we have Mr. Dan Pavan; from the U.S.A., John Durkin, Bernard Altmann, Art Clancy, Charles Hargrove, Juanita Moman, Richard Sanders, Betty Sanders, Ernest Streiner; from New Zealand, James Tritschler and Robert Williamson; from Australia, John Jackson, Jim Geddes and Lindsay McGregor; and from the U.K., Tony Westhead, James Hawes, Michael Barton, John Humphreys, Anthony Jarvis, David Kirk, Richard Leighton, Rosalind Kirk, David Or and Barry Smith. Would the House please make these visiting opticians welcome.

Orders of the Day

Hon. G. Clark: I call adjourned debate on second reading of Bill 71.

[ Page 3211 ]

MEDICAL AND HEALTH CARE
SERVICES ACT
(continued)

On the amendment.

D. Mitchell: I am pleased to resume adjourned debate on Bill 71, the Medical and Health Care Services Act, and in particular on the amendment moved last week by the member for Chilliwack.

For the benefit of members of the House perhaps I could read the amendment into the record so that it's very clear what we're debating here, because we're debating an amendment that I think is an important one. The amendment, of course, is to the motion that this bill now be read a second time; in other words, that the bill be approved in principle. Of course, we don't believe that the bill should be read a second time. The amendment, therefore, moved by the member for Chilliwack says: "Bill 71 be not now read a second time because: (1) the powers of audit and inspection allowed for in the bill will seriously compromise every citizen's right to privacy; (2) this bill will drive doctors, especially specialists, from the province; (3) the proration and capping of fees allowed for in the bill amounts to a rationing of health care and the introduction of a two-tiered system of health care in British Columbia.

That's what the amendment says. I want to put on record that I support this amendment. I'm sorry that I have to get up to support this amendment. The reason I have to support this amendment is because two previous attempts to amend the second reading motion for this bill have failed. I might remind hon. members of this House what they were.

The first one was an attempt to refer the subject matter of the bill to a select standing committee of the House. That amendment was moved in very good spirit. In all honesty, it was moved as an attempt to improve this bill, because the bill has been brought forward in haste. The bill, which is some 40 pages, is a very important bill governing the whole medical profession in our province, and it has been brought in in a very hurried fashion. We know what haste makes. We know that this bill and our House deserve better, when we talk about our legislative powers and our law-making abilities.

We suggested that this bill be referred to a select standing committee of the House for further study by all members of this House, and for input from the general public as well as from the physicians of this province. Perhaps when we come back for a fall sitting of this Legislature, we could deal with this bill and with amendments to the bill in a rational manner, in a manner that reflects wise decision-making rather than the hasty manner in which this bill has come to the House.

The throne speech that commenced this new first session of this new parliament suggested that the government was in favour of sending important matters to select standing committees of this House. In this whole session we've dealt with no topic more important than the matter contained in Bill 71, the new Medical and Health Care Services Act. Yet the government defeated the amendment. It chose not to accept that amendment which was offered in goodwill, in the very best of intent. It defeated that amendment. We were forced to try another angle. Having had that amendment defeated, we moved a second amendment to the motion. Our second amendment was a six-month hoist. What that amendment did was attempt to delay the second reading of this bill to six months from now. That was an attempt to allow time for study, to allow for exposure of this bill, to allow the public and physicians of the province to have some input so that the bill could be improved. It's simply an attempt to improve the bill. There might actually be some good in this bill, but there are significant things that are overlooked. Again, that amendment was defeated by the government voting against it.

We had no other opportunity to debate this bill further but to move a reasoned amendment -- a third amendment, which I just read into the record. This amendment, moved by the member for Chilliwack, highlights three of the main objections that we have to this bill. That's why I must speak today, although I wish I didn't have to rise to speak in favour of this amendment. I must speak to this, because I believe that the amendment is really the only alternative.

The bill should not be read a second time now. It shouldn't be read now, for the reasons that we've highlighted and for the flaws that it contains. This morning we came back to the House after being home in our constituencies on the weekend. We came back to the House after a weekend at home in our ridings, where we had a chance to talk to real people in the real communities where we live. We got away from the debating and wrangling.

Interjection.

D. Mitchell: I'm not suggesting for a moment that the member for Burnaby North is not a real person, but we had a chance to talk to real constituents in our communities over the weekend. While we were there, the government was engaged in negotiations with the BCMA. What happened? We were all listening very closely to news reports over the course of the weekend to find out what would happen. We were hoping that there could be some breakthrough in these negotiations. We were hoping that the government was truly willing to listen and negotiate in a free spirit and to listen to the doctors this weekend. We were hoping that we could come here today with the logjam broken, with an agreement in place that would allow amendments to take place to the bill, or for the process of approving this bill so that we can get on with the people's business and adjourn for the summer.

What happened this morning? The hon. Minister of Health came to this House and delivered a ministerial statement. We were very disappointed -- in fact, we were dejected -- to learn that not only did the negotiations not go well, but from her report to this House this morning, it sounded like there was never any intention for those negotiations to go well. In fact, it sounded very much like the constitutional negotiations at Meech Lake a few years ago, where there were last-minute

[ Page 3212 ]

negotiations with guns held to the heads of all the parties saying that there must be a deal. Of course, there couldn't be a deal, because there was no room whatsoever for compromise or consensus. We were disappointed to hear what the Minister of Health had to say today and with the tone of what she had to say.

Hon. Speaker, if there is room for conciliation, consensus and cooperation among all participating parties in this dispute, then the ministerial statement of the Minister of Health this morning did not reflect that. It reflected a further continuation of the adversarial approach that this government has taken from day one with this bill. The government has taken an adversarial approach when the people of the province have said they reject confrontation. If there's one lesson that we've learned from the election of last fall -- from October 17 -- it is that the people of British Columbia want an end to the confrontation, bitterness and polarization that has characterized public life in our province for far too long. That's what the people have told us.

Does the government opposite understand that? No, and I'll tell you why. They bring in a bill that sets up an adversarial approach in our health care system; that pits physicians against patients, the government and other stakeholders. It doesn't bring the parties together in the way that they must so that we can truly have a consensus-based approach to the problems in health care in our province. It doesn't do that. Instead, it furthers the old process of adversary against adversary and confrontation; it's wrong.

The government opposite criticized the previous government for the approach that they took to health care. At this point I would almost be willing to say: "Let's bring back the previous administration and their approach." At least they were willing to negotiate with physicians. This government has rejected open negotiations in any way. They simply said that they know what's best for the province, and they will tell us. They've told us in this bill. Bill 71 tells us that this government knows what's best. They don't have to listen to physicians; they don't have to listen to the opposition; they don't have to listen to the public. They know what's best. They have a monopoly on knowledge, and they're going to run the health care system the way they see fit.

It's a shame that they've had to go this way, and it's a shame that it has come to this in this province. We have to ask a question about who is in charge. Is the hon. Minister of Health really driving this process, or is it, as has been said so often, the Minister of Finance? We know that most of the crucial issues surrounding public health and our health care system are really financial issues. We know that the Minister of Finance and the Minister of Health both went back east recently to a meeting of their provincial counterparts from across Canada to discuss some of these crucial issues. We were hoping that they would come back in tandem with an approach that was more conciliatory and say: "We're going to consult with the people, the physicians and others who provide a leadership role in our health care system in the province." But what did they do? They came back and basically said: "It's our way or the highway." They came back with an approach that, if anything, was much more entrenched than anything they left with. The leadership that we've sought from the Minister of Health and, more particularly, from the Minister of Finance -- because we know that this is driven by financial implications -- isn't there. The leadership of our doctors in our health care system is not being allowed to have a voice either, because the government opposite will not hear that voice. Where is the leadership? Who is in charge?

This government cannot manage. They can't manage with an adversarial approach. They can't manage with a bill that doesn't clearly indicate who is in charge and who is operating here. The Minister of Health, who chooses not to be in the House during the debate on her bill -- and that's unfortunate -- will have to address some of these concerns in her closing statements. I hope that she's watching; I hope that she's listening; I hope that she's taking notes.

M. Farnworth: Point of order. Earlier today there was a point of order made that it was objectionable to refer to a member's presence or absence from the House. You ruled at that time that that was indeed a valid point of order. Again we are seeing the same thing. I would ask you to make the same ruling.

The Speaker: Yes, I would remind the hon. member who has the floor of that ruling this morning.

[2:45]

D. Mitchell: In a ministerial statement this morning the Minister of Health, as I said earlier, was taking a very adversarial approach. She implied, and she said outside the House after she left, that the doctors' only concern was money. She was attacking the physicians. In other words, she was continuing an attack that is most unconstructive at this point. When she was asked what the BCMA and the physicians wanted, she said: "They want only one thing -- money."

I ask you to think about your physicians so that you might consult them in your private life. Is that what motivates our doctors in this province? Is it only pure, naked greed, as the Minister of Health suggested, that is motivating the physicians of our province? Surely not, hon. Speaker. That's a shameful remark to make, and it's untrue. We know that among the physicians in our province are many caring people who have put years of their lives into training for service to British Columbians. They want to be consulted. That's the only thing they've asked for. They've only asked for what's reasonable. They want to be consulted so that they too can play a role in addressing the challenges in our health care system.

We know those challenges are formidable. Probably the single largest issue in public administration in Canada today is coming to terms with the challenges and the costs of managing our universal medicare system. We know that, and we want to play a role as an opposition in helping the government to that end so that we can guarantee that every British Columbian has access on the same basis, on a level playing-field, to the best-quality health care that can be available to them.

[ Page 3213 ]

We want to achieve that. I think that's what the doctors are asking for as well. They want to be part of the solution, not part of the problem. Unfortunately Bill 71 is punitive toward the physicians who should be taking that leadership role, and that's one of the major reasons that we can't support it.

There are a number of reasons why we can't support this bill, but one of the very dangerous things we're witnessing and hearing about right now is the possibility of strikes. We're hearing about doctors withdrawing their services. We've heard that in Prince George, northern British Columbia and Quesnel doctors are going to be staging a walkout on Thursday of this week. That is something that we, as members of the official opposition, do not condone. We can never support that, but we are sympathetic to the level of frustration those doctors are experiencing right now. We have to be sympathetic to the high degree of frustration they are experiencing because their voices cannot be heard. The government is intransigent. They enter into phony negotiations that are never meant to achieve any end, and they blame it all on the physicians. So we are sympathetic. We have empathy for those doctors who are withdrawing their services, but that's what it has come to in our province. It's come to the point where health care professionals -- the very best and brightest minds in our province who are operating our health care system today -- are being forced to express their frustration by withdrawing their services. It's a tragedy that it has come to that.

Last week in debate on this bill, on a previous amendment, I talked about the brain drain, and the fact that this bill is going to accelerate the move out of the province of some of our very best specialists. They simply don't want to practise here under the circumstances contained in this legislation, which they have had no chance to give any input to. That's a tragedy if it's going to accelerate the brain drain of some of the best specialists and some of the best medical minds in our province. They're leaving the province as a result of this bill. I think we all have to acknowledge, to be fair, that the bill must be wrong-headed.

I made some statements last week in the debate with respect to the hon. Minister of Advanced Education. I'd like to clarify that now, because the member for Burnaby North drew to my attention that perhaps the hon. Minister of Advanced Education did not say what I attributed to him. My interpretation of what the Minister of Advanced Education said last week was that he was effectively saying "good riddance" to those doctors who would choose to leave the province rather than to practise here. That was my interpretation of what the Minister of Advanced Education said. The member for Burnaby North drew to my attention afterward that I might have misinterpreted the minister. I've gone back and checked the records since then, and I can tell you the Minister of Advanced Education's comments certainly are open to interpretion. But if in fact I have misinterpreted his comments, I withdraw those comments now. I'd like to put that on the record right now. I would withdraw those comments if I have offended the Minister of Advanced Education in any way. But the point I was trying to make is an important one.

I would like to reiterate that. If this bill is going to accelerate the movement of some of the very best specialists in the health care field from our province to south of the border or wherever it might be, then that is evidence that this bill is wrong. We already have evidence through some of the letters that have been cited in this debate and through some of the other news reports in the media that it's already happening. It's happening on the North Shore at Lion's Gate Hospital, where we know that two experienced neurosurgeons have left the province to go practise elsewhere, and that's caused some problems. We know that's true, hon. Speaker, and that's a tragedy.

The government in our province sadly -- and this is my opinion -- with this bill is destroying medicare as we know it. I think that's ironic when you think about the traditions of the New Democratic Party, the genesis of health care in Canada and medicare in particular and Tommy Douglas in Saskatchewa leading in the vanguard for a national medicare system. Yet here we are in 1992 where an NDP government in British Columbia is actually leading the charge to destroy medicare in this province.

I don't think I'm exaggerating when I say that is going to be one of the effects of this bill, because it's going to bring in a two-tiered health care system. That's one of the issues that's addressed in this amendment. The capping and proration of fees is going to lead to a two-tiered system of health. It's going to lead to a rationing of health care that's going to put doctors in our province in a very difficult situation. It's a situation that really presents a moral dilemma for practising physicians who have been trained to serve their patients and to never deny the best quality medical care that they are able to afford and provide to patients who want it. Yet through this government's legislation, doctors are now being forced into deciding whether or not a patient will receive the health care that a proper medical diagnosis suggests they should receive.

Last week I read into the record a letter from Dr.Tony Chan, a practising physician on the North Shore, in which he wrote about the difficult and agonizing choice that he had to make about not performing bypass surgery on one of his patients. That is the kind of terrible dilemma that we are forcing our physicians into with this health care legislation. It's something that doctors haven't been trained to do; in fact, it's a violation of the Hippocratic oath that they take when they enter the profession. That's another reason why we cannot support this bill, and that's why the amendment standing in the name of the member for Chilliwack, unfortunately, must be supported.

It's important to recognize that in opposing this bill, the official opposition is supporting the public interest. The government opposite tried to suggest that we're simply supporting physicians or trying to defend one interest group, the B.C. Medical Association. Nothing could be further from the truth. In opposing this bill and deciding to vote against it and to vote in favour of this amendment, we are suggesting that it is not in the public interest for the government to proceed in this

[ Page 3214 ]

ham-handed manner without proper consultation with those who will be most affected. That's why we're supporting the amendment, and that's why we can't support the bill. We want to have fair and open negotiations.

We have not yet had one convincing argument from the government opposite as to why the bill must go through now. Why couldn't it wait until the fall or the spring in order to provide full exposure to the public of British Columbia? Why not provide the opportunity for the medical specialists, the physicians, the BCMA and other medical associations to have an opportunity to have full input into something as important as a legislative act, a statute of our province, that is going to affect every one of them? It's a reasonable request.

The government has not yet explained why it is important for this bill to pass before this House adjourns for the summer. That's why we're here in the first week of July to debate this legislation. We have other business that must take place. We have yet to pass the Health estimates, which represent about one-third of the provincial budget -- some $6 billion. We have a few other pieces of legislation that must be approved as well, which were introduced into the House as late as last week when the government was still introducing legislation. So we have some other business that we could be conducting while this bill goes out to the public and interested parties to be studied over the summer and, if necessary, the fall, and then they could come back next spring. There's no hurry. If we want to have the very best Medical and Health Care Services Act that we can have, then there's no hurry and there's no reason why we can't delay it until then.

In her closing remarks on debate in second reading of this bill, the Minister of Health is going to have to address some of these comments, and she's going to have to address some of the valid concerns that have been raised. She's going to have to tell us why the negotiations broke down this weekend and, in fact, why she ever entered into them if she had no faith that they could be successful. We remember very well that right up until Friday of last week she was still complaining about the doctors and criticizing and castigating them, until she went into negotiations with them. Then this morning, unfortunately, she continued to castigate them by calling them greedy and saying that they're in it only for the money. There hasn't been a genuine demonstration that this government is truly interested in consulting with doctors. There hasn't been a demonstration that the government is in anything other than in a hurry to get this bill through so they can have their summer holidays. I think that's shameful. For all those reasons, I must support the amendment that states very succinctly why this bill should not be supported and should not now be read a second time.

I'm sad that I have to rise in this House to do this today. I'm sad that it's come to this in British Columbia, where a newly elected government early in its mandate is trying to push through a bill in this manner. It's been referred to in the past as legislation by exhaustion. That's a term that many of us will recall from a generation previous. That's what we're witnessing. This government is simply determined to push this through at all costs, damn the torpedoes. They don't care what the opposition says. They don't care what the public says. They don't care what the physicians say. They simply want this bill passed. I say that's wrong. It's a negative approach to what the public process should be. It's a negative, non-consultative approach which denies all the promises they made when they were in opposition, all of the promises made in the last election campaign and all the promises made in the throne speech which commenced this session. It's negative. It's what the people voted against. This government hasn't learned their lessons. They've gone back on all the promises made -- and only eight months in government. They've shown a degree of hypocrisy which is shameful. For all those reasons, I cannot support the bill, and I must support this amendment.

H. Giesbrecht: I rise in this debate to oppose this hoist motion. I say that because it is, in fact, a hoist motion, albeit an indefinite hoist motion. The previous speaker presented the previous government as one that negotiated and consulted. That's utter nonsense, and he should know. He obviously hasn't spoken to any public sector workers in the past six years, perhaps even the past 16 years. We have had hours of debate. Almost all of the 17 members from the opposition have risen three different times on three different amendments for the customary or traditional half hour. What we've heard is something that applies in terms of that old adage: that after all is said and done, more is said than done. Almost 99 percent of it has been said by the opposition. All that has been done has been by the representative of the doctors and the Ministry of Health.

There are good doctors in this province. They're dedicated and caring. I speak from personal experience that they're far better than the opposition gives them credit for. They certainly deserve better than they're getting from the opposition, which brands doctors as rationing medicare, as being in a position to kill medicare and talk about user fees and that sort of thing. They're much better than that. Indeed, the people of the province deserve much better than they're getting from the opposition on this bill. The opposition's role -- and we've heard it time and time again -- is to debate, offer some alternatives, not delay simply for the sake of delay. There have been no constructive alternatives offered except to delay passage of this bill and do it by amendments. This amendment is no exception.

It would be appropriate during the committee stage of the bill to propose some well-thought-out amendments. Every constructive suggestion that's been made since this bill was introduced in the middle of this month has come from the representative of the doctors or the minister in the negotiations that have taken place. None have come from the opposition. I think that's an absolute shame. What they have engaged in is delay tactics. We've heard repetition beyond anything I could ever imagine in my first six months in this office. The argument doesn't improve with the repetition. That's something they perhaps haven't understood. The more I listen to the half-baked rhetoric, the more I'm convinced that this bill deserves a chance.

[ Page 3215 ]

Many years ago when my children were still young, we used to spend part of the weekend watching the "Bugs Bunny-Road Runner Hour" on TV. I could never quite understand, with the repetition, what my children found so entertaining about that. After about a dozen years -- and I haven't watched an episode since -- I've developed a new appreciation for the repetition in the Bugs Bunny-Road Runner show because I've witnessed it here in the past three months consistently. The repetition doesn't improve the logic, nor does the volume. I added that because the member for Richmond-Steveston entertained us this morning quite substantially in terms of the volume. The member for Richmond-Steveston also said that some of the amendments the minister has suggested in her ministerial statement this morning proved that they were, in fact, right after all.

[3:00]

I would like to read just for the record again, out of Hansard, that when the bill was introduced the minister said:

"Throughout the development of this legislation, government has sought the views of practitioners and consumers, received many helpful suggestions, and the bill has been improved as a result of them. Some of these discussions are still ongoing, and I say here again, as I have said in public before -- I recognize the time, hon. Speaker, and will be as quick as I can -- that we will be prepared to bring forward amendments at committee stage should we be able to reach agreement with the BCMA on the nature of those amendments."

That was on June 16. Again on June 22, just a short quote from Hansard: "My staff continues to be available to meet with the B.C. Medical Association to see whether we can agree on any further refinements to the legislation." That's ongoing, but from the opposition what we've gotten is an amendment which kind of includes a lot of politically self-serving rhetoric.

Let me deal with the first point. It suggests that it will compromise privacy. There is no control now in terms of privacy except in relying on a doctor's commitment to professional ethics. When I go to see a doctor, I have no way of knowing whether or not they talk about my case with anybody else, but I am confident that they don't do that. When I go to the lab for tests, I'm confident that the professionals there don't speak about my problem, if I have one, to anyone else. The only assurance we've got is that the professional doctor will treat confidence like a sacred trust.

I don't rely on the BCMA to defend my right to privacy. I rely on my family physician to do that, and I think we do a disservice by suggesting that Bill 71 will in any way compromise that. The audit that's been suggested in Bill 71 is for a specific purpose. That is accountability of costs, not to find out who's got what disease, not to be government inspectors as the opposition is fond of mentioning. It has nothing to do with government inspectors; it has everything to do with a professional doctor looking at accountability for health care dollars. So the fear tactic that's being engaged in is nothing more than self-serving political rhetoric.

The second point is that it will drive doctors out of the province. I would suggest that that was probably the same argument heard in Saskatchewan when medicare was introduced. No doubt some left, and there will perhaps be some so offended by Bill 71 that they might leave as well. I rather doubt it, but there may be the odd persons who have backed themselves into a corner and have no option but to leave. But it isn't a given. There won't be a mass exodus because of Bill 71.

People live in this country because it's one of the best places in the world to live. They live in B.C. because it's the best province in this country. Bill 71 is not going to change that. The option of going to the U.S. and practising medicine has a lot of other downsides. So to suggest that the doctors are going to engage in a mass exodus out of this province is not real. Again, it's a fear tactic promoted by the opposition, and it's politically self-serving.

The third point, of course, is the rationing of health care. I would guess that was probably the same argument that was heard in Saskatchewan prior to the introduction of medicare by Tommy Douglas. If a doctor decides that a patient does not require a particular treatment, that's not rationing; that is sensible medical service. You don't treat somebody who is not sick, and the doctors should be able to say that. To suggest that somehow they would ration health services is another insult on the professionalism of doctors.

Interjection.

H. Giesbrecht: The opposition has the audacity to suggest that Tommy Douglas would not have approved of Bill 71. I don't know what Tommy Douglas would have approved of. I do know that he knew he had to keep the province's finances in order; he did that before he introduced medicare. He probably would look at Bill 71 in terms of its accountability and be quite comfortable that we were doing whatever we could to preserve medicare. In order to afford the services and for the province to afford medicare, it's important that we get on with Bill 71.

I might add that if -- by whatever miracle the opposition is hoping for -- Bill 71 does not pass, they will be the first ones here complaining about why it cost another $60 million this year in MSP payments.

R. Neufeld: I rise to speak in favour of the amendment, against Bill 71 and on what I believe will happen to our health care system if Bill 71 goes through. It has been said quite a few times before that this government campaigned -- effectively, I might add -- on the fact that it would be open and honest, that it would consult with British Columbians before making any drastic changes to anything, including the labour laws of British Columbia. What is evident in the first session, within the first six months, is that that was a promise made to be broken. It's obvious that when you fly a trial balloon, as the earlier bill did.... Now it has been incorporated into another one -- Bill 71. They introduced it on June 16 -- if my memory serves me correctly -- and here we are on June 29 debating second reading. The government wishes to put this bill through in a hurry; it's called jamming it through the Legislature. I find that totally unacceptable for British Colum-

[ Page 3216 ]

bians, for myself and especially for my constituents. I stand here to represent those constituents in Peace River North and on the effect it will have on the health care of those people.

Bill 71 will incorporate changes in the health care system that will make it two-tiered. Unfortunately, it is unfair when we start making a two-tiered system of something which all British Columbians have always felt was their right -- to have complete access to medicare.

The people whom it hits hardest are those who live in the north. It doesn't matter whether it's health care or any other kind of service provided by government, such as services provided by Crown corporations; the people who get hit the hardest are the ones who live in the remote areas and, specifically, in the north -- and those are the people I represent. Constituents of mine have phoned me. They're worried about it, because they face greater costs than anyone down here does to avail themselves of health care services. That's unfortunate, because as I said, this was a government that said it was going to consult with the people, consult with all those concerned -- the stakeholders, which is the favourite term to use. Obviously with Bill 71 this government has decided not to consult with all the stakeholders. They know best, because they elected 51 members. All of a sudden they became experts in the field. "We're going to do exactly what we want to do."

I'll just back that up with a few write-ups that I have here and a few notes about some of the members when they were in opposition and how they thought the then government should have handled some of these problems. In fact, one of the first ones is about the now Minister of Labour, who should be the one who really understands how you should consult with people, how to get a consensus or something close to a consensus. The hon. Minister of Labour, when the past administration was having trouble negotiating with the medical profession a year ago, said: "The government should enter into fair negotiations with the physicians. If we were to form government we would take that type of approach to the bargaining table."

Well, when I speak in favour of the amendment to the motion and against Bill 71, I just wonder if that may be the reason the Minister of Labour has absented himself from the House so much lately. Because some of this is coming to light; it's coming to bite him in the heels, as you could say. He talks about consulting, about talking to the stakeholders, and then all of a sudden by magic -- an election, pardon me, and then magic -- he ends up on that side of the House with a totally different viewpoint. That's indicative of almost all members opposite who were here before on this side of the House. They all had those opinions.

The Minister of Advanced Education. This is a quote out of a newspaper. It says his name, but I'll use "the hon. Minister of Advanced Education." He said: "The only solution to dispute seems to be binding arbitration, on the condition that Couvelier vows to accept an arbitrator's award and the doctors realize the province is in a financial crunch." It's amazing, when you listen to that minister speaking here a number of days ago. That wasn't even in his vocabulary. He had totally forgotten about it. He was the critic for health care at that time, I believe. How could he so quickly forget some of the words of wisdom that he delivered just a year or so ago?

I'm going to read another one. This is a quote from the Minister of Advanced Education in the Hospital Employees' Union paper. It's a little lengthier, so I'm going to read part of it into the record. The title is: "Government is Out of Touch." Amazing, isn't it? That's exactly what the opposition is saying now to those members. It says:

"B.C.'s health care system is seriously ill. From unconscionable waiting-lists for heart, eye and hip surgery to mounting discontent by professionals and workers, the symptoms are unmistakable. Throughout B.C. I encounter the same problems time and time again: overworked, undervalued nurses" -- and physicians; it's amazing -- "physicians frustrated they can't offer their patients the highest standards of care; institutionalized cutbacks without improved support for community services; little people falling through the cracks."

We have to remember that this was the critic for Health -- who is now the Minister of Advanced Education -- speaking on behalf of his caucus at that time.

"My diagnosis: government is seriously out of touch with the problems in our health care system and the need for coordinated, long-term planning. My prescription: it's time for a change and fresh look."

I assume that he is talking about an election. We had the election, and now we're waiting for the fresh look. We haven't seen it yet.

"Health promotion and high-quality sickness care must be mainstays of health care policy. Here are a few health priorities."

This is interesting. It says:

"End the climate of confrontation between government and B.C.'s health professionals. A cooperative working relationship with doctors, nurses, pharmacists and all other health workers is essential."

Ramming through a bill that is going to totally change the health care system in British Columbia, and something that one part of the system is not happy with -- which happens to be the medical profession.... I don't think we're going to have a happy medical system if we have unhappy doctors. Continuing down this road that we're on now, we're going to have unhappy doctors. I think that it's showing where some areas are closing their facilities. The doctors are walking out. They're saying: "We can't do it."

[3:15]

I'll go back to the advertisement. It says:

"Ensure equal access to necessary health services throughout the province. Absurdly long waiting-lists for surgery must be eliminated. Northern British Columbians..."

I thank him for thinking about northern British Columbia at that time, but now that he's on that side of the House, he's forgotten that there's a northern B.C.

"...need better programs to ensure equity with city dwellers. Coordinated planning for community health service delivery. End moralistic interference in health care. Abortion must be treated as a health service. People with AIDS must be treated with compassion and dignity. The AIDS epidemic demands responsible and urgent action to save both lives and tax dollars. Deal

[ Page 3217 ]

with the preventable root causes of ill health. Poverty and violence against women and children often establish lifelong patterns of ill health. Without society's commitment to eradicate these scourges, much of our health promotion is nothing but talk.

"It's frustrating to meet many creative people in the health field who are increasingly discouraged about where we are headed or to read complaint letters from patients who can't get basic services for which they pay heavy taxes. I know we can do much better in B.C."

I thank the minister for those wise words. I would hope that now he would continue those wise words into the cabinet discussions along with his counterparts in how they're going to deliver health care in British Columbia. Part of it, as he also says -- as does the Minister of Labour -- is consulting with those affected. That just isn't the people who pay the taxes, but it is the doctors, the nurses and all those associated with delivering those services.

I've listened to another member of the back bench, who is a newly elected person in this Legislature like me. He spoke a year ago, in February 1991, about health care and what was happening in British Columbia at that time. I just want to take a few quick.... It's pretty lengthy, hon. Speaker, so I don't think you want me to read everything. I am not going to; I'm just going to read some of the items that stand out the most.

This is the member for North Vancouver-Lonsdale: "We have to have doctors if we're going to have a health system. Ideally, we should have doctors and government minimizing what is inherently an adversarial relationship." That comes from a new member who was, over a year ago, talking about adversarial relationships between the former administration and the medical profession. He professes that to have a happy and good system, we need to have all the players and stakeholders maybe not agreeing on everything, but at least agreeing on most things so that they're happy. I want to make sure you understand that he's not criticizing his own government; he's talking about the Social Credit government. He says: "I criticize the government a whole lot for not representing the public interest. I criticize the government even more for not being open and honest and truthful." My goodness, they had it back then. "I don't consider misleading statements and half-truths to be lies, but they come awful close, and it upsets me a whole lot." That's the member for North Vancouver-Lonsdale, who has spoken in the House a number of times on what was happening with Bill 71 and why it was so good.

There are a few more quotes that I should read, so the people of British Columbia fully understand, when he gets up and supports Bill 71 fully and completely and that they have completed all those obligations that he talks about being open, honest and consultative -- that they haven't done that. The government has not done that, or they would have had some kind of an agreement by now. It's obvious after the last weekend that the talks broke down because there is no agreement. I'm not saying that the medical profession is totally right; I'm not saying that the government is totally right. I'm not saying that any way at all. What I am saying is that the government has the responsibility, by being elected as a government, to work with that profession until they come up with an agreement that will work for both of them, not just one side or the other.

It seems to me that what this government wants to do.... I appreciate that they're faced with some costs; I know that the medical budget is the largest one. I know it represents one-third of the total budget. They still have to sit down, on behalf of the people of British Columbia, and collectively work out what's best for all British Columbians. What's best for all British Columbians is not what that enlightened group thinks their position is. It's somewhere in between; that's where we have to work toward. That is what has happened before. Every government has arguments with the doctors. I was on a radio program in my home town the other day, and I had some medical professionals phone me and give me a hard time because they had difficulty in negotiating with the Social Credit at times. That's true; I think that always happens. But in the end, what was agreed to was collectively agreed to by both sides, not just one side, for what they believe is their driving force.

The member for North Vancouver-Lonsdale also, in the notes I have.... I'll read one more paragraph:

"It's very important that people understand that this is not an exercise in doctor-bashing. If there had been an NDP government and we had been deadlocked in these negotiations, we would have looked. And the president of the B.C. Medical Association, Dr. Frye, said that she'd been calling for months for binding arbitration. Before we had given away the shop on cost control on computers or a sweetheart deal on pensions, we would have said: 'Yes, Dr. Frye. Let's submit our differences to arbitration'."

There comes a time when this government has to start living up to some of the promises it made in the past in dealing with the medical profession and dealing with all parts of British Columbia, because, my goodness, this is just the start of it. I think earlier today in the House it was mentioned that there's been more labour unrest in British Columbia in the last eight months than there was in the last six years. I submit that that's probably true; but it shouldn't be. Really, if this government is representing what they say they represent.... But obviously they've let some feelings out that there are going to be some people who are going to receive a whole lot more than others, and for some reason the medical profession is catching it in the neck right about now.

We're talking about a bill that's going to totally change the way health care is delivered in the province. We talk about the amendment to the motion, the powers of the audit and inspection -- for the government to be able to appoint someone to come in and look at confidential files. That is the fear of a lot of people, because they don't want just anybody looking at their files. They don't mind telling their doctor their special little secrets, but they don't want somebody in the government or a collective group saying that somebody else can now come in and look, take those records from the office and decide whether this doctor is billing the system rightly or wrongly.

That is a big budget: $6 billion. That is an awful lot of money. I submit to you that we cannot begin to attack

[ Page 3218 ]

the increase on our health care that each and every one of us holds so dearly.... We cannot totally control the costs of the health care budget by just looking at a number of the top professionals. If we're going to seriously look at the cost of health care in the province today, tomorrow, in the next ten years and in the future, we have to somehow devise how we're going to do that, and that's not by just limiting a few doctors on what they make.

That isn't going to work. That's just like going to the construction union and taking out the painters and saying: "Well, I guess you guys are the highest-paid part of this construction industry. We're just going to cap your salaries and you're going to have to live on less than everybody else for the next four or five years, whether you like it or not, and that's tough." That doesn't work. Of course you're going to have turmoil, and that's why they have turmoil now. This is a bill that will put a cap on doctors' fees, and doctors are going to have to decide while they're talking to their patients what services they're going to deliver -- whether they can afford to deliver them or not. If they don't make that decision, they'll continue on the way they are, and in about nine months' time they'll all be in Florida -- other than the ones who will stay here and work for nothing. Then where will we be?

Systems were worked out before. When you reached a certain amount of money in the health care budget, the doctors took a percentage cutback and the government paid more. That system worked. Why can't we continue with something in that vein? Changing the health care system the way this government is wanting to do is certainly not going to be beneficial to all British Columbians and especially not to those constituents I represent from the northernmost part of the province.

I often go back to the Seaton report, because I think it was well documented and took a lot of time to develop. That report said that all we had to do was change how we delivered health care to British Columbians, and we could almost live within the budget that we have. Well, we've added $400 million to it, we're going to hire 700 more health care workers, and we're going to cut the doctors' salaries. It's certainly not the way the Seaton commission talked about delivering health care in British Columbia. I know that's a pretty simplistic way of saying it, but it is almost bang on what the Seaton report said. You can live within the $5.6 billion or $5.7 billion that you had before; it's just a matter of how you spend that money. Obviously this government wants to up the employment statistics for British Columbia by hiring 1,500 more full-time employees collectively through the whole system, or 700 into health care -- and advertise all across Canada. A tremendous amount of money was spent in advertising. I think we could have kept that money at home and maybe kept our own people busy.

The hon. member over here asked how much, and I would venture to say it was about $9,000 a page in the Montreal Gazette. I don't imagine he would know that unless he read back a bit in the Blues. I think the budget was around $100,000 in advertising, if I remember correctly, but I'm doing that off the top of my head.

[3:30]

I spoke before on Bill 71, and I now speak again in favour of the amendment to the motion on Bill 71. I think that with this bill, if it really is all the government says it is, and each and every part of it is needed, there should be no fear from this government to wait until the Legislature is called again next fall, as we seem to be told it's going to be, so that people -- British Columbians, physicians, people within the medical system -- have until that time to go into the bill, discuss it and feel confident about it. The people of British Columbia right now don't feel confident about our health care system -- especially our seniors. Those are the people who are most affected. They don't feel comfortable. It's not each and every one of them, but the ones who are watching and listening who don't feel comfortable with what's happening.

I guess the fears that are coming back to them.... They saw the Premier of the day, during a televised debate, hold up an American Express card and a CareCard and criticize the then government for doing something to our medical care system. Well, it looks like we're going to make a two-tiered system in British Columbia now with that government -- and that person is now Premier; he isn't the Leader of the Opposition. I just wonder if there wasn't an underlying message from the Premier when he held up those two cards, knowing full well that this was some of the plan that they were going to bring in -- Bill 71 -- to change the health care system where some may get it and some may not. Maybe he knew; maybe he had the premonition that there was going to be a drastic change. Obviously he would, because he was a member of the opposition for long enough to know that they had something in mind as to what they were going to do with medicare and how they were going to handle the costs in the medical system in British Columbia. So there he is, large as life, holding up an American Express card and a CareCard, and it's slowly coming to pass that we may have a two-tiered system delivered by that person.

That is why people in British Columbia are concerned, and that is why I've said that if it's good legislation it will stand the test of time. If it's fine legislation and it's what's needed in British Columbia at this time, people will accept it. They will go along with it. There is no problem. But they will have a hard time going along with it when you try to push it through the House in a hurry.

There are a lot of people who don't understand this system or how it works -- when governments decide they want to push something through in a hurry, what they're trying to do, that there's some underlying reason someplace. It's not leadership that does this; it's the lack of leadership. It's the lack of leadership and the lack of confidence in your own legislation, that it will not stand the test of time, and you try to jam it through the House in a hurry by exhaustion. That's what this type of leadership is doing to the province of British Columbia.

I want to talk a little bit about doctors' salaries -- what they make. Again, I'm going not by what's been delivered to me by the Medical Association but by what I have researched and found. I'm going to read this part

[ Page 3219 ]

of it. B.C. physicians earn $91,315 a year. This is a Revenue Canada figure. Physicians average a work week of 56 hours, or 243 hours a calendar month -- Price Waterhouse study.

As much as we went through this House on different financial institutions and what not, deciding what was right and proper in the province of British Columbia.... I would think that that's probably the average salary for the average physician in the province. Let's round it out to $92,000; that's easy to remember. Now to someone making a salary of $35,000 or $40,000 a year, that's a tremendously big salary. But I know how much time doctors in the north put in and how much they're on call, because we're always short of doctors. When you think that we pay high-school principals in excess of $80,000 a year for nine months' work, deputy ministers about $104,000, school superintendents in excess of $100,000, city administrators from $80,000 to over $100,000 a year.... The IRC commissioner makes $115,000 a year; the director of patronage makes $73,000 a year; the Crown corporations secretary makes $108,000; and the Energy Council chairman makes $100,000. I would add that most of those are also backed up with pensions that are contributed to by the public purse in a far greater amount than what the doctors' are. We have doctors, those we depend on mostly for our health care system, making an average of $92,000 a year. I think we should be a little bit concerned. Just recently the Minister of Finance took the freeze off those who make over $79,000 a year in the public service. Yet we're attacking one section of the medical profession, the doctors, who are not unionized. Maybe that's the problem, hon. Speaker.

The Speaker: I regret, hon. member, your time has expired.

H. De Jong: Hon. Speaker, I just wish to speak very briefly on this amendment. [Applause.]

An Hon. Member: Be nice.

H. De Jong: Well, I'm usually not lengthy, so I guess they know this by now.

I've said before that I think that negotiation through legislation is not the way to go. Certainly the passage of this bill is intended to do just that. I don't think the public, the medical profession or the government are well served by it. I think it behooves the government to take a second look as to what is really going on in the communities. I'm not putting all the blame on the government, nor am I putting all the blame on the doctors.

I'll just give you an example of what I was called about just half an hour ago by one of my constituents. His mother, who is in the upper seventies, attended an eye specialist. Apparently she needed a cataract job on one eye and a laser job on the other. But before she could get this type of service, she was told by the specialist that they would have to pay $50 rent for the laser machine to be used for the eye that needed the laser job. We can call it what we want, but it really becomes a user fee.

If, in fact, the intent of this bill is to cut out those specifics, and if the people who are providing the service have an understanding of the limitations that are presented with Bill 71, then it's no wonder that the opposition is opposed to what is being presented in Bill 71, and rightfully so. This debate should continue, because I believe that if the general public can no longer trust the medical system that they have enjoyed and were entitled to for so long, and that is now being eroded -- or tends to be eroded -- by Bill 71, then surely the government should take another look at it.

The bill, as I said earlier, is being used as a bargaining tool. It's not right, has never been right and never will be right to use legislation for the purpose of bargaining. So I again want to urge the government, particularly the Minister of Health, to give this bill careful consideration and, as the amendment says, postpone it for some time so that these issues can be properly looked at, discussed and understood by all parties. I think, if I sense the complaint I had from that one particular citizen, that neither one of them understands what Bill 71 is intending to do. Therefore I think the amendment is appropriate, sensible and should be acted upon.

L. Reid: I rise this afternoon as the official opposition Health critic because there is a principle at stake here. Second reading is debate in principle, and the principle of universal health care is what must be protected this afternoon. Allow me to consider the words of Dr. Ling. He writes: "Health care is the single most important concern for British Columbians. Legislation affecting health care needs to be carefully considered, and ample opportunity for debate and discussions must be provided." In his view, the government of British Columbia is acting too hastily in trying to ram Bill 71 through this Legislature. This individual is from the area of Kitimat. They are hoping that this bill is withdrawn.

There must be meaningful discussion with all health care providers before drastic changes are introduced, or we risk the demise of what has been an excellent health care system. The people of British Columbia deserve good legislation, debated for as long as it takes to arrive at a plan that will serve British Columbians well for years to come. This individual feels very strongly about that.

In my view, Bill 71 is bad news for the health care system and for health care consumers. Who are these health care consumers we continually refer to? They're taxpayers. They're the people who create the system. They're the folks who fund health care delivery in British Columbia -- each and every single taxpayer in this province -- the individuals who carry around the British Columbia CareCard that my colleague referred to. This is the very same card that the current Premier, prior to the last election, had the audacity to wave around at British Columbians, suggesting somehow that he had the answer to resolving health care and delivering universal health care in this province.

I would suggest that at one point in the life of this current New Democratic administration we will see the wording on that particular health care card changed. It

[ Page 3220 ]

will say, in addition to the card being the property of the province of British Columbia and that it is to be presented when using all provincial health care programs, including the Medical Services Plan: "Please note that the care provided to you within the province of British Columbia is now limited."

This bill is about rationing health care. Our health care system needs a commonsense approach. No one will win if this government continues to be entrenched in their narrow focus. Some months back I had the opportunity to write an open letter to the Minister of Health in the province of British Columbia. My closing paragraph was: "We do nothing if we pit one aspect of the health care system against any other. The education system in our province did not benefit from teacher-bashing. The medical community will not benefit from doctor-bashing."

[3:45]

This issue is bigger than the income we provide to physicians in this province. I think the Minister of Health would have us believe that it is a narrow, tidy little issue in terms of how many dollars are available for health care delivery. It's not that simple. This is a much larger issue. This is how we deliver health care in the province. We're looking for creative solutions and a recognition from this government that the costs of health care are shared costs. It is not appropriate to suggest that any one group must bear the entire cost of delivering quality health care within British Columbia. Restructuring health care requires a certain maturity, and I certainly do not believe this current government has demonstrated any particular level of maturity as it relates to the delivery of health care in British Columbia.

This morning in her ministerial statement, the Minister of Health somehow suggested that she had resolved the conflict as it pertained to the Professional Association of Residents and Internes of British Columbia. I have a letter dated today's date.... They believe the hon. minister misled this House, the government and the province's taxpayers:

"...the minister assured us of her support for our contention that we should not be treated in a discriminatory fashion and agreed to seek an appropriate amendment to the act which would address our concerns."

Again, this is coming from the Professional Association of Residents and Internes of British Columbia -- practising physicians, not students.

"Unfortunately, the proposed amendment suggests that differential treatment would not be permitted on the basis only of 'age or gender.' Needless to say, this does not address our problem at all. Frankly, I am astounded that if the intent of this legislation is not to discriminate against doctors entering or in the early years of practice, it is so difficult to provide an amendment explicitly excluding them from such treatment."

David Forrest, president of the Professional Association of Residents and Internes of British Columbia, writing as of today's date to suggest that when the Minister of Health in her ministerial statement at 10 a.m. today somehow suggested: "No, they don't have concerns. I have taken care of that. Be reassured that that particular group will not be discriminated against in this piece of legislation...." That is abundantly untrue, and is an issue that needs to be put to rest today.

Also this morning the minister tried to separate the future of medicare from this issue. This issue is the future of medicare. This is the issue facing the province at this time. We have the term "blame" continually tossed out there. Why is that considered any response at all to a very complex problem? Restructuring health care is a huge challenge. Realistically it will not be done in any given budget year. In fact, it should not be pursued in concert with the discussion of physicians' salaries. They are separate and distinct issues. Again, if I might give the example of education: you do not see the education ministry in this province going forward at any time with the restructuring. Let's use the Year 2000 document as an example of how we deliver educational programs to our young people. We don't see reasonable Ministers of Education tying that discussion to how we negotiate salaries with our teachers. Those are separate and distinct entities, and they must be continued as that. To put them together only clouds the issue in the eyes of the public, only muddies the issue in the eyes of the public and, I believe, misleads the public as we go down this road.

The minister, in her ministerial statement this morning, suggested that the physicians in British Columbia had called for a slush fund. The fact is, this Minister of Health has a slush fund. It's called the health special account. Opposition members on this side of the House suggested strongly.... Brenda Parkes, the young woman from Nanaimo with the petition that carried 72,000 signatures, said that any dollars, especially those flowing from 50 percent of lottery proceeds in this province, be directed to urgent health care priorities. What we now have before us in a health special account -- slush fund, if you will -- is the general expenditure of dollars anywhere from education to consultation. No, I do not accept the notion that the physicians were advocating for a slush fund, but I would suggest that the minister is intimately aware of how slush funds operate.

The minister also suggested this morning that you somehow do not require two visits to a physician to have a Pap smear done in this province. What, both the physician and the patient wait 48 hours in the office to preclude having two separate visits? It takes a minimum of 48 hours to have that test carried out appropriately. That's standard practice, and I do not believe that the Minister of Health, who is not a physician by training, can deem that to be inappropriate.

I am speaking very strongly in support of this amendment for all the reasons that I have stated. The restructuring of health care in the province requires more than ten days of debate. Debate in second reading is on the principle. In our view and in the view of many British Columbians, all of whom are taxpayers, we are looking at a bill that has the potential to seriously compromise every citizen's right to privacy. That is a huge issue. When I look at the government side of this House, do I feel reassured when they say that it's not a problem? No, I'm not feeling reassured by that "trust me" stance, because they have done nothing, in my

[ Page 3221 ]

view, to earn the trust of this official opposition or of British Columbians at large, who are taxpayers.

This bill will drive doctors from the province. I think that is a given. You will find serious professional people -- not just doctors -- leaving when it becomes common and accepted practice to insult them at the outset of negotiations and at the outset of an understanding; and in this case, to have insulted and tarred an entire profession during the introduction of previous legislation in this House. We had Bill 13 and Bill 14, and we now have Bill 71. Each and every piece of legislation that I have now mentioned did nothing but decry an entire profession by suggesting that they weren't honest, hardworking people.

The Minister of Health suggests that she was misquoted in today's paper when she suggested that doctors were overpaid and underproducing individuals in our society. If you are truly committed to believing that all those professions have something to offer, you don't make inflammatory comments like that and then retract them. It won't do at the end of the day. We have the official retraction, but that does not go any distance to repair the damage that has been done to serious professionals in this province who, in my view, do not deserve to be treated badly.

I would not suggest that the mission of any administration is to treat any group or individual taxpayer badly. But I can tell you that many groups in this province feel that this administration has treated them badly, and that is certainly not isolated to physicians. Unfortunately, it just happens to be their turn. But who is next in this government's whitewashing of the true facts and their sense that they are saving the common person? That's absolute rubbish, in my regard, and it's rubbish that will not continue to be perpetuated in the minds of the public.

With Bill 71 we will certainly be looking at a rationing of health care. That is the logical consequence of limiting the number of dollars that you will pay for health care in the province. When they run out of dollars, the government and the minister have suggested that further health care will not be available. That is rationing; that is an elimination of a service. It is not appropriate to continue to whitewash that as somehow being in the public's best interest. I'm not convinced that the average British Columbian taxpayer -- the patient -- would ever believe that this government was acting in their best interests if they were not able to acquire the service they so desperately need in an emergency situation. They will not thank this government for doing them any favours.

Another issue I would take forward at this time is the timing of this particular piece of legislation as it fits into the overall legislative package of this NDP administration. In my view, the biggest issue before us today that must be addressed -- I understand by midnight tomorrow -- is Health estimates. We have $6 billion that somehow we're not prepared to look at with every single legislator present in this House. We're talking $6 billion for a health care system. Health estimates were called on June 22. They had planned to be finished by June 25, if you believe the rhetoric -- four days, $6 billion. The same comment must be ascribed to Bill 71 -- tremendous upheaval and restructuring of the system in a little over ten days. I cannot accept that as being a reasonable approach, and I can tell you that my constituents are looking for reasonable government. They are looking for a reasonable approach in this province. The fact that we have not handled Health estimates carefully is one more example of this government's inability to manage its legislative program. Reasonable legislators do not, I believe, bring forward a budget item of some $6 billion days before the House is supposed to rise. It makes limited sense and only lends credibility to the fact that the NDP administration in this House is simply not prepared to govern, in my view.

[The Speaker in the chair.]

My constituents, the taxpayers in this province, are looking for and deserve reasonable government. I can tell you that I have many pieces of correspondence, mostly from taxpayers in this province, folks who believe that they have every right to expect reasonable health care from their practitioners and have a reasonable system in place from their government. I also have a number of physicians who have come forward who are, as well, taxpayers within this province. One individual from Squamish, Dr. Quiring, suggests that:

"Last year after office expenses my income was $65,000. I spend more than 50 hours a week directly related to my job, and this gives me an hourly income of $25 an hour. After this I paid $21,000 in federal and provincial income tax. A nurse gets $24 an hour plus at least a dozen benefits, which brings her employer's costs to over $35 an hour."

We are somehow suggesting that our physicians can work for a whole lot less, and we're somehow suggesting that that's a saleable item that we can somehow sell to the public. I can't sell that to my public. I can't sell that to my constituents.

This individual continues: "A certain amount of common sense is all that is needed to reduce some of the costs of health care." I would certainly concur. This official, Liberal opposition in British Columbia has put forward many reasonable, reasoned arguments as to why this particular government need not go forward at this time. Our first amendment spoke to that. Our second amendment spoke to that. An unprecedented third amendment has spoken to that. People expect decent consideration from their legislators.

We have a Dr. Thompson from St. Paul's Hospital who believes "that Bill 71 is unnecessary, unjust and likely to be harmful to the health care...system in British Columbia." That is the issue that we are speaking to in our third amendment, the very same amendment that suggests that we take time to look at how important all of these issues are and how important they are to the delivery of health care in this province.

Again, we have an individual from Victoria, Dr. McCaw: "The physicians of Victoria support the principles of medicare as defined by the Canada Health Act. We have worked hard to make a success of it and are concerned that the proposed legislation will lead to a system which will be unacceptable" to the public at

[ Page 3222 ]

large. Hon. Speaker, that is the commitment that needs to be recognized and acknowledged. At the end of the day, universal medical care -- our health care system in the province of British Columbia -- belongs to the people it serves. We have to recognize that. I'm not convinced that this government has recognized that.

[4:00]

Health care will be rationed in the province of British Columbia because, simply, the Minister of Health doesn't have any better ideas. The rationing of health care must be laid squarely in the lap of this Minister of Health. The demise of medicare must be laid squarely in the laps of all government members. These issues are too important and too costly to the future health of British Columbians to sugggest that once we get through this, we will somehow magically have a better health care system.

Bill 71 is 41 pages long. It was introduced at the end of the legislative session, when we can't give it reasonable time, and when this government is unwilling to take it to the people for scrutiny. My point is that this legislation must be satisfactory to the people it was designed to serve: the patients and the taxpayers in this province. This government is not allowing for that. Somehow this government has decided what is best for taxpayers in this province. I can't support that. Quite honestly, we have a number of individuals who can't support that, such as Dr. Wray this morning. "This bill is particularly sad when you consider that physicians' billings have decreased as a portion of the total health care budget since 1986. We have been doing our job at cutting back health care costs; no one else has." This individual is absolutely right. Physician billings in this province have either stayed constant or have decreased. It is not appropriate to lay at the doors of the physicians that they're somehow responsible for the costs of health care.

Hon. Speaker, we're looking at $1.27 billion of a $6 billion budget. We need to be prepared to be reasonable and to look at the entire $6 billion package. Hopefully we would never ever again believe that it's appropriate to bash any one aspect of the health care delivery system that we as taxpayers in this province enjoy. That is the issue we have before us today, and somehow the members of this government have justified the position they have taken. I find their position unacceptable.

Dr. Wray continues: "When this government was running for election, the Minister of Health promised the physicians of this province fair access to negotiation." I would submit that upwards of thousands and thousands of letters have come forward, not just to members of the official opposition, but to every single MLA in the province of British Columbia, because their constituent base believes that the person they elected in their constituency is their representative. I can attest to the fact that it is not just the Liberal opposition who have received correspondence. I would go so far as to say that I can prove it. So many letters I have been copied were addressed to the Minister of Health, the Minister of Finance and to many members of the government.

These are not issues that we have somehow uncovered; these are issues that need to be brought forward and that need to have the true light of day shone upon them. Again, Dr. Wray says: "One has to ask how far this government will go with its lack of concern for health care in this province."

When I opened my remarks this afternoon, I said that the issue was the future of medical care in this province. That is what physicians are speaking to; that is what taxpayers are speaking to. When they go into their doctor's office, they want their CareCard to mean something. They want it to stand for something. They want to be able to believe what it says on the back -- that they will be eligible for the services they've always been able to receive.

This legislation doesn't allow for that. In fact, this legislation rations where we're going in this province. One of the comments this individual makes is: "The government says there are too many doctors, and yet my patients still have to wait months to see a specialist or consider going across the border to get urgent health care concerns addressed." We're not doing ourselves any favours, and we're certainly not doing our constituents any favours, if we somehow suggest that capping salaries is going to address the concerns about where, and in what time-frame, they receive their health care. That is a problem today, prior to Bill 71. Putting Bill 71 on the table is only going to compound that problem; it is not going to resolve it. Again, my view continues to be that this bill will restructure health care. As it stands, it's not going to restructure health care in a positive way. It's unwieldy. It doesn't make a great deal of sense. It doesn't have the support of other care groups, other providers in this province.

In my opinion, this government had a glorious opportunity to be forward-thinking. They had an opportunity to resolve some really serious issues. They had an opportunity to come forward and say: this is what we want our health care system to look like in six months, in a year, in five years' time, in ten years' time. We're working towards something very critical here: the next decade in the delivery in health care. It doesn't just apply to British Columbia. It applies to every single province in this country and probably to every country in the world. The next ten years are going to be critical, because they will decide how we go forward in the delivery of health care.

What the official opposition has asked for is time to look at this bill. The public has asked us for that opportunity. That is a reasonable request. It's a significant request. It's a request that allows for reasoned debate. It's a request that allows for public education. Certainly the Minister of Health spoke of that this morning -- that we will magically have programs in place that will educate the public. All of a sudden they will know how their utilization of the system incurs costs. I can appreciate the intent of that, but I can assure you that no change of that magnitude is going to happen in this budget year or in the next budget year. That is a five-to ten-year educational cycle, a process that this government has not bought into.

Somehow Bill 71 is being tossed out as the placebo, the answer. Somehow it's going to magically take away the rough edges and make the rationing of health care more palatable to British Columbians. No, it isn't. It

[ Page 3223 ]

simply removes the scrutiny of the immediate issue, which is rationing of health care, and whether or not we as British Columbians want to continue to have universal access to medical care in this province.

I would submit to you that we do, and I would submit to you that the official opposition in this province is well and truly behind practitioners who have said: "We are prepared to look at treatment protocols. We are prepared to put together guidelines of practice." This is not a new attempt to somehow soften the blow of Bill 71. This is an ongoing commitment on behalf of practitioners in this province, a commitment that extends back ten to 15 years. This is not something they have dreamt up in the last few days. They have been committed to this process, because they believe in access to universal medical care. Frankly, we're giving them less and less reason to continue to believe in a system where the administrators of that system, if you will, have golden opportunities every single day to bash them. We are somehow holding up universal medical care and saying: if you don't buy into what we have said, if you don't allow us to market it to you in this particular way, you will somehow be responsible for the end of medical care in this province.

Hon. Speaker, let's close the loop on that. If medical services in this province come to an end, they will come to an end because of the government of British Columbia, not because of one of the players in the field. Make no mistake about that. There is a role of responsibility that must be recognized: the responsibility for the future of medical care rests squarely in the lap of this government. There is no other answer. There is no other truth that can somehow be elicited from this discussion.

In my view, this glorious opportunity for forward thinking has been given away by this government. It is simply not interested in pursuing it. We're not clear as to why, because the goal lines tend to change every few moments, depending on what press conference we happen to be in. It's a concern for me. Health care in British Columbia is in a mess, not because of the practitioners who deliver health care but because it is being impacted upon by poor legislation -- poorly understood by the government, poorly understood by the public. The government is marketing it as something it simply is not. It is and needs to be about how we restructure health care. It needs to be taken seriously by every single taxpayer in this province -- every single recipient, every single consumer. Quite honestly, it is in the government's best interest to advance medicare on behalf of all British Columbians. Given the entire lack of respect shown the physicians by this government, I'm convinced that they must be asking themselves why they should continue with medicare. Quite honestly, it's not in their best interest.

This government hasn't consulted the dentists yet, who currently directly bill their patients. Let me assure you, hon. Speaker, this is not about user fees. Direct billing is a different issue. Should this government continue on this bent, and patients in this province find themselves directly paying for service when they visit their physician, the backlash on this government will be tremendous, and there will be no one left to blame but themselves. As it stands, rationing of health care will be the only outcome of Bill 71. Bill 71 is not responsible legislation.

Blame is easy; blame is convenient. However, the cost of health care must be shared by everyone. We must recognize that. We have lost confidence in this minister's ability to manage our health care system. This government promised an end to confrontation; this has not been delivered. We would ask that this government either be prepared to take a serious look at how it delivers health care, or this minister should do the honourable thing and resign.

The Speaker: Seeing no further speakers on the amendment, I will read the amendment before you: "that all the words after 'that' be deleted and 'that' be followed by:

"Bill 71 be not now read a second time, because (1) the powers of audit and inspection allowed for in the bill will seriously compromise every citizen's right to privacy; (2) this bill will drive doctors, especially specialists, from the province; (3) the proration and capping of fees allowed for in the bill amounts to a rationing of health care and the introduction of a two-tiered system of health care in British Columbia."

[4:15]

Motion negatived on the following division:

On the main motion.

Hon. G. Clark: I hadn't planned to rise in debate on second reading, but I thought I would make a few remarks today.

Bill 71 is an innovation. When you look around the country, I think you'll see that it is an innovation designed to be more cooperative than in most administrations in terms of trying to deal with managing our health care system. Bill 71 is about saving the medicare system as we know it. It's about our medicare system in this country, which is very much in the hearts and

[ Page 3224 ]

minds of all Canadians. The previous Prime Minister of Canada called it a sacred trust, and it truly is.

Hon. Speaker, the medicare system is under a great deal of pressure across the country, pressures to undermine the system. There are pressures to impose user fees, pressures to deinsure services -- in other words, not to provide universal access to the full range of services that we have today -- and pressures to eliminate health care coverage for a whole range of services.

When I attend Finance ministers' meetings, as I have on a few occasions now, or joint Finance and Health ministers' meetings across the country very recently, it is quite clear that the medicare system as we know it is under attack from underfunding by the federal government. That is a great deal of the problem. What has happened is that we are seeing a drive for user fees across the country, led by the three Liberal governments of Newfoundland, New Brunswick and Quebec. At every single Finance ministers' conference we hear the Liberal government of New Brunswick raise the demand for user fees. We on this side of the House reject that notion of reforming health care. We believe in universal access to health care. It was our movement, our party, that brought in health care, over the objections of the Liberal Party of the day in Saskatchewan and over the objections of doctors, heaven forbid. Over their objections we established a system which is a model for the world, and Bill 71 continues a tradition, which the New Democratic Party established in this country, of saving medicare, reforming medicare, retaining universal access to medical services and not having a two-tiered system, one for the rich and one for the poor.

Is it any surprise, hon. Speaker, that Liberal governments are driving for user fees? The answer is no. It's no surprise, because that party has a history in this country, when it came about in Saskatchewan and elsewhere, of being opposed to the medicare system. Hearing what the opposition has had to say in this debate, if they had their way, there is no doubt in my mind that we would have user fees in this province as well.

It is clear that the Liberal Party is in the pockets of certain elements of the B.C. Medical Association, certain elements that are opposed to universal access to medicare. They are in the pockets of the B.C. Medical Association.

Hon. Speaker, this dispute between the government and certain aspects of the BCMA has boiled down to money and to universality of our health care system. The doctors' leadership is demanding $50 million to $100 million more in '92-93. We had it on the weekend; we had it last night. They're not content with what I think will be the second-or third-largest increase for medical services in the country. Over and above that, they want special provisions for a slush fund; they want special provisions for a northern allowance; they want special provisions for other aspects of the medical profession. And they want us to rely on special warrants, as the previous government did. The bottom line is that they are demanding some $50 million to $100 million more this year alone.

That's bad enough, as we all know, but what else have they asked for? And it is the "else" that concerns me more. They have asked the government of British Columbia to delete reference in Bill 71 to the Canada Health Act. What does that mean? It would allow medically necessary services to be delisted, or deinsured. It would make it possible for the government to make people pay for medically necessary services. That's what the B.C. Medical Association demanded last night at 11 o'clock. They demanded that we amend the bill to take out the reference to the Canada Health Act. That is not what this government is going to do, nor is it what British Columbians want. Yet the Liberal Party stands up here hour after hour and mouths support for the BCMA. We have to assume they also support deleting the reference to the Canada Health Act, and that's shameful.

In addition, they asked us to give them money by deinsuring exams for prescription eyeglasses. In other words, they want us to reduce service to British Columbians so that more money can go into doctors' pockets. It's as simple as that. They actually demanded that this government deinsure the tests that people receive for eyeglasses, which they now get for free. They demanded that we make people pay for that, take the cost saving and give it to doctors. This government is opposed to that as well.

Worse than that, the Liberals, by their actions in here, demonstrate they're in favour of that kind of tactic, because they have taken the BCMA position, lock, stock and barrel, in this House. The B.C. Medical Association has asked that, in addition, we eliminate any reference to extra-billing their patients, because they would like the right -- or they would at least like not to be prevented by law -- to extra-bill their patients, and they would like the right to opt out of medicare, out of this sacred trust we talked about that British Columbians and Canadians want to see survive. The doctors have asked us to allow them the right to opt out and to extra-bill, and the Liberal Party stands here for hours and hours and defends the B.C. Medical Association. As long as we're the government, there will be no opting out and no extra-billing in this province.

We have the pitiful sight of the Liberal Party of British Columbia coddling up to the BCMA executive, an executive in my view not representative of the vast majority of doctors in this province. If you had phoned the BCMA over the last week or so and asked for Dr.Finlayson, the staff rep, you'd have got a recorded message. That message says they're not in right now, phone this number; and if you phone that number, you get the Liberal Party opposition. Shame on them!

They have had staff people from the B.C. Medical Association, paid by the B.C. Medical Association, sitting in their offices for weeks on end here, telling them what to say in this House. Their lips move, but it is the staff people from the BCMA who are sitting there giving them advice day in and day out. It is shameful that we would see BCMA-paid staff people sitting in the House telling the Liberal Party what to say, and that they don't have the respect or the integrity to stand up to that and speak their own minds in this House. But I guess they don't have it because they have sold their 

[ Page 3225 ]

souls to the B.C. Medical Association. Sitting in the legislative precincts are paid staffers from the BCMA. They pull the strings, and the Liberal MLAs mouth. Their mouths open, and they're puppets doing their bidding.

It gets worse. The Minister of Health has said that this dispute is about money. It's about money -- and we all know that -- but we thought she was talking about money for doctors. Now I have a letter, a shameful letter, written by the Leader of the Opposition to every doctor of this province asking for money -- asking for financial assistance to the Liberal Party to fight Bill 71. This Liberal opposition is bought and paid for, and it's shameful. The best opposition money can buy sits right here -- the Liberal Party -- day in and day out. They pretend to be standing here concerned about health care or medicare. They don't care about health care. They don't care about universal access. They don't care about user fees. They care about money for their own pockets and for Liberal Party pockets, and they're using this as an excuse to fund-raise among doctors in this province. I think it's disgusting. It is shameful. It is nothing short of scandalous that the Liberal Party would filibuster a bill in this House and stand up and mouth the words of the BCMA -- and certain elements of the BCMA at that -- while they secretly mail a letter asking for money in the pockets of their partisan interests. This has nothing to do with health care; it has to do with their own vested interest, their own personal gain and their own political gain. It has to do with them shamelessly using this dispute -- the future of health care -- for fund-raising. I think that when all British Columbians find out about this, they will be disgusted by it. Perhaps they will shorten the debate and talk about real issues that concern British Columbians instead of trying to line the pockets of the Liberal Party.

[4:30]

In the last day or two, what the BCMA has said is the bottom line. Their bottom line is that they want user fees; they want the right to opt out; they want the right to extra-billing. They want to deinsure services from British Columbians, and they want more taxpayers' money put into their pockets. The inevitable result of what the BCMA has asked for is a two-tiered health care system: one for the rich and one for poor. On this side of the House, we will fight that even if the opposition is bought and paid for, and they will say whatever the BCMA asks them to.

Every single speech made by the opposition reinforces the view that they support the BCMA leadership and certain aspects of it that have dominated the news. It is not in the interest of the public. The opposition should rise above this and talk about the public interest and not about vested interest. They represent narrow, private interests in this chamber, the likes of which we have never seen before in this House. We have seen a vested interest pay for their opposition, sit there in the precincts and provide free research services. I think it is shameful.

We have a fiscal crisis in this country the likes of which we have never seen before. We have inherited a $2 billion deficit that the government is trying to deal with. In spite of a fiscal crisis, we have increased funding for doctors and medical services in this province by 4.7 percent. This is one of the highest increases in medical services in this country. If you take a look at Saskatchewan, they voluntarily took a minus 5 percent in the funds allocated for doctors' billings in that province. What has happened in this province? This government has taken a reasonable approach. We have compromised every step of the way. We have provided the most reasonable funding, in spite of our fiscal situation, for doctors and other public services. In spite of that, this opposition demands that we give doctors more and more, because they're bought and paid for.

The Speaker: Order! Would the member take his seat. I would hope the hon. member who has the floor was not impugning the motives of any other hon. member in the House by that comment.

Hon. G. Clark: I would certainly not personalize it. It's a Liberal Party position, and I don't mean to impugn individual motives.

Let me tell you that doctors in this province opposed the medicare system. They went on strike in Saskatchewan when we brought in the Canadian medicare system.

L. Reid: Point of order. I ask that the hon. minister withdraw those comments, which I believe did impugn the motive of this side of the House.

The Speaker: Order, please. Hon. member, I did in fact ask the minister if he did intend to impugn the motives of any hon. member, and he has said he did not.

Hon. G. Clark: When medicare was brought in in this country not that long ago, the doctors fought it. They went on strike in Saskatchewan. What has happened in the intervening years, in my view, is that the majority of doctors in this province and this country support our medicare system. It is absolutely correct to say that there are many thousands of hardworking doctors in this province who deserve to be paid well, and they are. We have no intention of trying to undermine the kind of medical services provided by health care practitioners in this province. We want to support them. We want to work with them. That is why we have brought in Bill 71, which is a compromise bill. It is an attempt to have practitioners as part of the solution in this province. We have asked them to work with us. It is not too late. When this bill passes, the mechanisms will be there to give the kind of co-management of our health care system that will be the envy of the rest of the country.

Members and British Columbians should know that this government is not backing down on user fees. It is not backing down on extra-billing for doctors. It is not going to allow opting out or the undermining of universal medicare in this province. We will do everything we can to ensure, protect and enhance our medicare system as we have come to know it over the last few years. Bill 71 is an improvement. It is a way in which we can deal with these fiscal crises together. It is a way in which we can buy people into the solution. I

[ Page 3226 ]

am convinced that cooler heads will prevail. This bill is essentially a positive bill, and the vast majority of doctors who have an interest in medicare and this province will work with the government of British Columbia to ensure that we maintain the kind of universal health care system that we all desire in this country, in spite of the fact that the opposition continues to be bought and paid for and use a narrow special interest, which is advanced by a minority of doctors in this province.

I ask all members to vote in favour of Bill 71.

Hon. E. Cull: I'm pleased to be able to close debate, to address some of the many points raised during this debate and to try to bring a little reality to exactly what is happening with Bill 71.

I want to start by reviewing how we got to where we are right now. The member for Okanagan East said: "Well, why didn't you bring this bill in at the beginning of the session? If you've been working on it for so long, why didn't it come in right at the beginning?" I want to take us through the history that got us here.

We established a budget this year on March 26, as part of the provincial budget, that was $58 million over last year's expenditures -- a 4.7 percent increase over last year's expenditures. That's twice the rate of inflation and an amount that, I daresay, many in this province would like to see as an increase this year.

Bill 13 was brought in as a budget bill at that time to try to allocate this budget in a way that we thought would be fair and equitable for doctors. It was a progressive bill in the sense that it provided bottom-end loading -- a very progressive concept. The majority of the money would go to those doctors with the lowest billing. Only 300 doctors would be affected by the cap. But the doctors of this province said they didn't like it. The day after, on March 27, when the budget came in, I said: "Fine. Our position on medical services in British Columbia is that we have established a budget that is fixed. It is the obligation and the responsibility of this Legislature to fix that budget. If there are other ways for allocating that money, another pattern of distribution, then that is negotiable." That has been the position since March 26.

We have been trying very hard over that time to negotiate in good faith with the doctors a way of allocating that money that will meet their needs, but more importantly that will meet the needs of the consumers and the taxpayers in this province. Bill 71 arrives here today as the result of those discussions over a long period, over three months of intensive discussion since the budget came in and since many of the amendments, which go back before that.

Bill 71 is a creative, innovative solution to a problem that we have been trying to address through discussion with the province's doctors. Having said that, I believe that when this joint commission is in place -- where, for the first time in this country, the public, the doctors and the government will be sitting down with equal representation to make decisions about how medicare is delivered and managed in British Columbia -- that will be one of the guiding lights, one of the real highlights in this country as to how medicare is provided. Other provinces will start to look to us to see what we're doing here.

As much as I like to talk about the fact that we're leading the way in some of those issues, I have to tell you that there is a lot of stuff in this bill where we are not leading the way or cutting new ground. Six other provinces have already brought in caps on their physician budgets. Some of those provinces have regional caps; some of them have specialty caps; some of them have income caps, like in Bill 13. You don't hear any of the medical associations in those six provinces saying: "The sky is falling. We're going to have to leave the province. We're going to have to go somewhere else and practise medicine. Patients won't get their care." Even in Saskatchewan, which was mentioned by the speaker before me, where the budget for medical services this year has had a great decrease, you don't hear those kinds of comments. So you have to wonder what is going on here in B.C. If we can just start to look over the Rockies and see what is happening in the rest of the country, why -- if this is working in six other provinces -- does the Medical Association in British Columbia believe it won't work here?

Well, I think it has to do with money; it has to do with doctors' incomes. It doesn't have anything to do with medical care. If we don't look at the rest of Canada, but we do what some of the members of the BCMA think we should do, which is to have a look at what's going on in the United States, I have here a news article from June 18 from the Herald, which is in Washington State. The Washington State Medical Association has asked the government essentially to bring in a Bill 71 in Washington State. They want to create a health insurance czar. They haven't gone quite as democratic as a commission. They want a health insurance commissioner appointed by the government to set premiums and specify minimum benefits to be included in insurance coverage. The commissioner would also be required to assess new medical technologies and determine whether they're to be covered. They have asked for that kind of approach to be brought in.

I'm really concerned, when I listen to all the speeches, that the opposition hasn't taken the time to really read the bill. Unfortunately, as I listen to some of the comments made by physicians around this province, I believe that they haven't taken the time to read the bill either. When I talk to doctors.... I guess I'm fortunate. I probably have the most doctors living in my riding of any member of this House; I have 300 of them. When I talk to my constituents on the phone and start to tell them what is in the bill and clarify some of the misinformation that has been spread around about this legislation, there is great understanding of what we're trying to do.

The opposition has spent a lot of their time talking about their abhorrence of the confrontation that has come up around this. But I have to say, hon. members, that you are contributing in large part by fanning the flames of conflict, by providing misinformation, by carrying on rhetoric which isn't accurate when you have a look at the bill.

What am I talking about here? Let's have a look. I've heard many people on the other side talk about income

[ Page 3227 ]

caps, saying: "You're freezing doctors' income." There is nothing in Bill 71 that provides a cap on income. They say there is no room for negotiation in Bill 71. Bill 71 provides for arm's-length negotiation, as occurs right now between the BCMA and the government personnel services division of the Ministry of Finance. That kind of fee-schedule negotiation will continue to happen under Bill 71. As we worked trying to find some common ground with the BCMA over the weekend, we moved this one step forward and suggested that if those negotiations could not be resolved through a negotiated process, we would bring in conciliation.

[4:45]

This bill provides for fair negotiation. I keep hearing, time after time, members who obviously haven't read the bill saying that this bill has stripped doctors of their right to negotiate. What it has done is say that they will not be able to negotiate about the budget that's spent on health care. I think that's fair. That's our responsibility. It's the responsibility of every member in this House to do that. We don't allow the teachers to negotiate the education budget, much as they might like to. Nurses don't negotiate the hospital budget. We have to recognize that we have a responsibility to set and manage budgets. We have a responsibility to people who make a living as a result of these budgets, to negotiate with them about their fees and benefits, and we'll continue to do so.

I hear statements that Bill 71 cancelled the master agreement. I defy you to find a statement or clause in this act that has anything to do with the master agreement. The old master agreement has some clauses which are repugnant to the bill. But, from the beginning, we have said that we're willing to re-establish that framework with them, bring it into line with the legislation and allow it to continue.

I hear members saying that this is putting all control in the hands of the government. Again, I have to conclude that you haven't read the bill. As I said when I introduced the bill in the Legislature....

The Speaker: Order, hon. member. Through the Chair, please, hon. minister.

Hon. E. Cull: As I said when I introduced the bill in the Legislature, there's an element of risk involved in this bill, because we are giving up some of our control. We have had a situation where the Medical Services Commission has been entirely within the control of the government. We are now saying that we consider medicare and its future to be such an important issue in this province that we will share responsibility for important decisions with the profession and, most importantly, with the consumers and the taxpayers. Our three-party commission doesn't put all control in the hands of the government; it gives up some of our control to the people of this province and the medical profession.

I keep hearing comments about clawbacks. I want to put that term in context. The term "clawback" was first used by the B.C. Medical Association, which used it to characterize a deal it had negotiated with the past government, where it agreed to share in overutilization. The BCMA agreed, through a contract, that it would pay back this money. When it came time to pay the bill, they didn't just pay it; they complained, they called it a clawback, they said it was unfair, even though they had sat down and negotiated it. Whether that was legitimate or not because it was negotiated, I have to tell you that there is no provision in Bill 71 which will allow for a clawback of money that has already been paid to doctors for services rendered. There's no provision in here to do that, and we will not be able to do that. The only thing we will be able to do is have a look at utilization, and say in the future, "Gee, we're really running over budget," the way anybody would if they were looking at their own budget in their own household, and say: "Time to tighten the belt a little. We're going to have to try to spend a little less in the next period."

The last thing I keep hearing is that there is no dispute-resolution mechanism in this legislation. That is exactly what the Medical Services Commission and its three-party component is designed to do: to create the kind of arbitration panel that we would create if we were to resolve these disputes. That three-party Medical Services Commission will have the power to make the decisions at their level. They won't have to go off to cabinet. They won't have to go off to third-party arbitrators. They will be the final decision-making body.

They talk about lack of consultation. I want to talk about lack of honesty in some of the things that are being said about consultation. There's a chronology that the opposition was reading from when they were talking about what had happened in terms of consultation on this bill. I have to wonder, as my colleague from Vancouver-Kingsway just said, why the Liberal opposition would rely entirely on the research of the B.C. Medical Association when they're supposed to be trying to represent the public interest. The chronology of events, which the B.C. Medical Association says is true and complete, has left off a couple of important dates. For the life of me I can't understand why they would not want their members to know that their president at the time, their president-elect, their executive director, met with the Premier on April 6. Why don't they want their members to know that they had a meeting with the Premier and the Minister of Health? Maybe it was an oversight; maybe it was a typographical error; maybe they forgot the meeting. But it seems to me, when you're talking about a true and complete chronology of events, that you might not leave off such an important fact.

They talked about a telephone call from me on June 2 demanding, as they say, "a midnight ultimatum." But they've conveniently forgotten that earlier that day, June 2, they started faxing letters to me saying they didn't think they could reach any agreement with this government by the end of this session. The agreement that we had on June 2 was that we were going to take our understanding of where we were back to cabinet and their larger board respectively. It was important to know what message to take to cabinet. But they don't even talk about the fact that after leaving the meeting on May 31, where we thought we had reached some tentative agreement, things started falling apart for

[ Page 3228 ]

them -- they changed their minds and started faxing letters. And they start putting out chronologies like this.

It's very difficult to talk about consultation when one party seems to be totally fixed on a confrontational agenda. It's very difficult to talk about consultation when the other party is waging a $3 million negative advertising campaign every day, and saying: "Yes, but we really do want to consult." I have a feeling that consultations cannot happen in that kind of climate. We want to end the confrontation, but not at any cost. The people of this province expect us to defend their interests and not trade them away just to get out of a situation that is getting a little bit heated.

You know, we're working with nurses, community health care providers, dentists, hospitals and the chiropractors. Chiropractors have said: "On behalf of both the B.C. College of Chiropractors and the B.C. Chiropractic Association, I thank you for Bill 71."

Interjection.

Hon. E. Cull: The critic says: "Tell us again how you're working with PARI-BC." I suggest that she do her research, call David Forrest of the Professional Association of Residents and Internes and find out what the position of PARI-BC is about the amendments that we've discussed with them today. I think you'll find that contrary.... You're not up to date, unfortunately. You've got to keep your researchers working all weekend, not just 8 a.m. to 4 p.m. during the week.

I'm very concerned when the member for Vancouver-Quilchena talks about the Oregon model and suggests -- I assume this is not just an idea that he came up with in the middle of his speech, but is a position of the Liberal Party -- that we have a look at the Oregon model. I suggest you take a second look at the Oregon model, because it was a process whereby middle-class people who had private health insurance sat down to figure out what poor people should get in the way of medical services covered by state health insurance. They cut off some things that I think are pretty unacceptable. People dying of AIDS in Oregon -- when they were at the end of their disease -- were cut off the list. I think that's shameful. I think it's unacceptable. If the Liberal Party stands for a two-tiered health care system along the lines of what's been developed in Oregon, then let them stand up and say that. Let them tell the people of this province that that's what they stand for.

I've heard many people from the other side say: "Who's going to receive treatment? Who's going to decide who's going to receive treatment?" Let's have a look at some of the research that has been done. The Liberal opposition leader says that we need to do more research and more studies, and that we don't know what's happening. There is a wealth of medical research on what's happening in health care in this country, and what we learn is that up to 30 percent of the medical treatment happening right now in Canada may be unnecessary. It doesn't improve people's health; in fact, if you're receiving unnecessary surgery, it may be harmful to your health. A U.S. study showed that about 250,000 patients die every year during or after surgery. They said 12,000 of those deaths occurred as a result of unnecessary surgery.

The members opposite are saying those are U.S. studies -- what about something in Canada? Let me tell you of one of the best studies, which I think shows what we're talking about here when we talk about unnecessary surgery. There was a study of hysterectomies done in Saskatchewan between 1967 and 1971. During that time period the number of hysterectomies rose 72 percent, and then suddenly dropped by 33 percent. What happened? Did all the women leave the province or something? Of course not. What happened was that the government did a review in 1972 about the need for this surgery, and suddenly it was not as medically necessary as had been thought before. When someone starts asking questions about the kinds of things being prescribed for patients, sometimes doctors' behaviour changes.

There is some very interesting work being done right now on interactive videos and prostate surgery. When men go through this they learn what the risk is, what the possible outcomes are, and more and more are electing not to have surgery. That's as a result of having information. They are questioning their doctors, and rightly so.

The other question that has been asked on the other side is: who is going to make these decisions? I've heard members say: "Doctors shouldn't make decisions about who gets health care or what kinds of health care. They shouldn't be making the decision." I've actually had doctors tell me that. You tell me, who better than doctors to start making some of those decisions? They have to work with us on this. They can't just say: "We'll just do whatever our patients ask us to do." That's totally ridiculous, and I don't believe for a moment that good physicians in this province do that. Doctors tell me they don't want to turn patients away, and neither do I want to turn them away for necessary surgery. But I do want to say no to unnecessary visits, unnecessary surgery, unnecessary tests and unnecessary procedures.

The Liberals have been saying it's not the doctors that are the problem; it's those bad patients. They've been talking about how it's the patients, and the poor doctors can't do anything because it's the bad patients coming in. Let's be reasonable about this. We both have some responsibility. The patients have some responsibility; the doctors have some responsibility. The BCMA has been arguing with me for some time now about something they call patient participation. If we had patient participation in health care, we'd have more patient responsibility.

Hon. members, patient participation is a euphemism for user fees. That's what they want. They want user fees to make people decide whether or not they're going to see their doctors. We know that there is a direct relationship between health and wealth. The more income you have, the more likely you are to have good health. We don't want people to have to question whether they've got enough money to make it to the end of the month or whether they should take their kid to see the doctor and pay the user fee, because those are precisely the people who need the help the most.

[ Page 3229 ]

Rather than patient participation, we will support the system through patient and practitioner education. We will support doctors through the development and implementation of guidelines and protocols to back them up when a patient comes in and wants a test that a doctor thinks is unnecessary. What we won't do and will never do is support user fees as a way of determining who does and who doesn't get health care.

I've heard a lot of talk in this chamber in the last couple of days about the audit provisions. People have been suggesting that we just go to the patterns-of-practice committee and allow it to continue; that is a committee that has done some very good work. It has not -- in the words of Dr. Hardwicke -- been able to work quickly enough. It takes up to 18 months to investigate whether a particular physician is operating well beyond the norm. At that rate, it is going to take us an awful long time before we can start zeroing in on doctors who are responsible for utilization going up. The Leader of the Opposition said that there have been no studies on this, but there have been studies. We know that the number of doctors in this province has been growing much faster than the population growth. We know that the number of services provided per patient is growing much faster than anything demographics would indicate in terms of aging.

There are some very perverse incentives in the fee-for-service system. Doctors don't get paid for listening. They get paid for cutting, putting things into people and for prescribing drugs. I think we should have another look at this and try to devise a system that rewards doctors for taking some time with their patients, sitting down with a senior citizen and reviewing her lifestyle. To do that, we have to change the way that we provide fees. We have to make the money we have in the system work smarter for us.

[5:00]

I hear all this scare stuff about the audit provisions. We're not going to be leading the way in audits. British Columbia will be the eighth province in Canada to bring in audit provisions when this bill becomes law. In Newfoundland, where they brought in audit provisions before they even did their first audit, the notion of audits saved them 2 percent in their utilization. If we're that successful here in British Columbia, we will save $50 million right off the bat from audits. This bill won't have the slightest impact at all on doctors' fees.

Doctors and the opposition have worked together to scare patients. I am really concerned about the scares that we've had around confidentiality and what will happen when people come in and look at their records.

Interjection.

Hon. E. Cull: The member opposite says: "They mentioned user fees." The people who have been suggesting user fees....

The Speaker: Order, hon. members.

Hon. E. Cull: I refer the hon. members to the document, which I'm sure they had probably only minutes after I had it last night. It is the memorandum of agreement that the BCMA suggested we sign. They say in their chart that one of the things they want to have in here.... They use another euphemism here: they talk about co-payments. I think that's a user fee.

Interjections.

The Speaker: I would call the House to order so that we can all listen to the debate.

Hon. E. Cull: The proposal that the BCMA leadership made to us last night says that they want the government to undertake to give them a guarantee that we will not introduce or enact any legislation that will prevent or inhibit a medical practitioner from charging patients directly at a rate which may exceed the Medical Services Commission rate. That is a user fee. This organization is arguing for user fees, and the government has said that we will not be bringing in user fees.

The other thing that I've heard talked about when we were talking about the audit provisions was some concept of government inspectors going in and looking at your medical records. We have made it clear in the legislation, in the debates in this House and in the discussions with the B.C. Medical Association that we are talking about medical practitioners who will be looking at medical records. Medical practitioners -- the doctors -- are bound by their Hippocratic oath, and they are bound to confidentiality. As I said, we will be number eight in Canada when it comes to having this legislation. But the members opposite should also be aware that hospital records have been audited for decades, and I haven't heard any comment about that.

I want to talk a bit about the fear tactics that are being used right now, because I think that they are particularly repugnant. The Liberal House Leader read a letter into the record some time last week from a doctor to the daughter of his patient, saying that unfortunately, as a result of Bill 71 -- which hadn't even been brought in yet -- he was not going to do surgery on that woman's mother. Doctors have told some of our members or their staff not to expect to receive medical care in this province. Some doctors have said that to people who are associated with the government. Doctors in Prince Rupert have put out a flyer telling women that they will have to travel to Vancouver and pay $5,000 to have a baby. This is irresponsible and unprofessional, and I think it is possibly unethical. It's about time the Liberals realized that the interest of medical care in this province does not lie solely -- or equally -- with the interests of the BCMA leadership and that there is a broader public interest. Frightening a pregnant woman in Prince Rupert is far more hazardous to the health of that individual and to the health of medicare than anything contemplated in the legislation that we're bringing in.

The Liberal critic said in her remarks on the main debate that this issue is bigger than doctors' incomes, and I agree with her. I wish that the BCMA would get off doctors' incomes and realize that there is a bigger issue here that we're talking about. This bill and this debate is about the future of medicare in this province. It's about how we make sure that we manage health

[ Page 3230 ]

care dollars to meet the needs of all people, not just the needs of one practitioner group.

We are fortunate here in B.C. because our economy is better than in the rest of Canada. We're in a situation where we've been able to provide more money to health care this year. We have to make sure that we spend it wisely and that it meets the other needs for community care, for hospital care, for the mentally ill and for the many other services.

I need to wrap up, and I want to read some quotes to the House: "Doctors will abandon the province in droves." "This action is a tragic mistake." "This will lead to a poorer quality of health care." "It will lead to rationing of health care." "We need more time." Are these quotes about Bill 71? No, they're from the Saskatchewan Medical Association in 1961, supported by the Saskatchewan Liberal Party, to oppose the introduction of medicare for the first time in this country.

Despite all the rhetoric, this fight is about money. Dress it up however they like, that's what the BCMA is fighting for. Tommy Douglas promised medicare in Saskatchewan in 1944, and he was fought for 18 years by the Canadian Medical Association, the Saskatchewan Medical Association and the Saskatchewan Liberal Party. We are not going to wait 18 years to bring about the reforms that are needed to protect medicare. We will take the tough action that is needed. I invite the Liberals to understand the public interest in this as opposed to the narrow interest of the leadership of the BCMA and join us to preserve medicare for our kids and our kids' kids.

The Speaker: The motion before you is second reading of Bill 71.

Motion approved on the following division:

[5:15]

Bill 71, Medical and Health Care Services Act, read a second time and referred to a Committee of the Whole House for consideration at the next sitting of the House after today.

Hon. G. Clark: I call Committee of Supply.

ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS

The House in Committee of Supply B; E. Barnes in the chair.

On vote 48: minister's office, $365,941 (continued).

R. Chisholm: Many services in the hospital are required on a 24-hour, seven-day basis, yet most community-based services are able to run efficiently only on an eight-hour, five-day basis. This is particularly true where programs require a clinical nursing component, as in the psychiatric outreach programs. Unless specific traffic volumes warrant, it can be very expensive to provide the required switchboard-reception-screening personnel on a 24-hour basis in the community, yet the hospital is required to maintain these services as part of the normal operation. Thus it would appear to be more appropriate to administer a home IV program, for example, through the hospital, since the safety and comfort zone of the patient is increased greatly. Failure to supply appropriate 24-hour support will only result in increased traffic at the hospital emergency department and a corresponding increase in costs. Does the minister have an answer to that for me, please?

Hon. E. Cull: We are doing both: home IV through hospitals and through continuing care.

R. Chisholm: Is that in consultation with nursing personnel?

Hon. E. Cull: Yes, nurses provide those services.

R. Chisholm: There are also concerns about the methodology of shifting people resources from hospital to community. As hospitals are expected to downsize, human resources will be transferred from hospitals to the community. There are many unresolved issues of seniority, union jurisdiction and licensing involved in a shift of responsibility of this magnitude. The hospital has built up a considerable pool of administrative expertise over the years, which may be currently only in its infancy in younger community organizations. How do you perceive your resolving that problem of the shift of personnel from one area to another?

Hon. E. Cull: We covered labour adjustment extensively in earlier debates on this, and I'll just say that we are working with the major hospital unions to develop a strategy. I gave lots of details the other night, and I encourage you to have a look at the Hansard record.

[ Page 3231 ]

R. Chisholm: Hon. Chair, through you to the minister again -- and hopefully I'll get an answer on this one.

It is to be expected that as some types of patients are moved from the hospital to the community, the hospital will be left with patients who on average are relatively sicker and require more care than before. This expected increase in the level of acuity in the hospital population indicates that the hospital budgets should not be cut on a per capita basis but rather should be allocated with regard for necessary levels of clinical service as well as to meet the public's rising expectation of health -- sickness and care -- systems. Do you have any answer for that one, hon. minister?

Hon. E. Cull: I think the member is bit confused about the kinds of transfers that are going to be taking place. The acute-care hospitals do provide services to people who are acutely in need of services. If people are not requiring acute care, then they shouldn't be in the hospital in the first place; they would be better served, from a health and a cost point of view, in the community.

Where his question might have some relevance is in the desire to keep seniors longer in their own homes. This means that they do arrive at long-term-care facilities at a higher level of need. Again, that was discussed extensively the other evening. I made reference to the fact that we have made small increases in the budgets of long-term-care facilities to deal with that.

R. Chisholm: My final question to the minister. A survey called the Gartner Lee report was done, and it has been reported as having two different levels of report, one for media consumption and one for government use. Can you verify that there were either one or two levels of this report?

Hon. E. Cull: There is only one report, but the complete report contains a large number of maps and other material that are very difficult to copy. The full text of the report has been made available, and the report with all of its maps, etc., is available in health units, union boards of health and at a number of other places. I think municipalities.... I'm not sure of the full list, but it is readily available. Some documents are very difficult to copy.

R. Chisholm: Can you tell us what the difference between the federal report that has come out and this report is?

Hon. E. Cull: No, I'm sorry, I don't have the answer to that. I would be happy to get it and get back to the member in writing.

L. Fox: I have a few questions with respect to chelation treatments. I was pleased to hear the minister talk earlier about the need to review some of the procedures and look at ways and means of cutting down the costs. I know from the two files of correspondence and stuff that I have that the minister has been apprised of the procedure, and I am sure she has had the opportunity to look at the great length of data that has been given to me.

Has the minister or her ministry given any consideration at all to reviewing whether chelation is something that we as a province want to recognize as a legitimate treatment and an alternative perhaps to some of the heart surgery that we presently have taking place within the province?

Hon. E. Cull: I too have received many letters about this issue and a request that we consider it for certain kinds of conditions which it's currently not approved for. Chelation therapy does take place for some conditions but not for all, and until it's approved by the federal government -- they have the responsibility -- we can't extend it here in this province.

L. Fox: Could I take it from that that the ministry sees that as something it would advocate the federal government recognize in order that we might deliver this service? Obviously it does take place throughout the province, but often it takes place in motels or whatever under the supervision of specialized doctors. If there is an opportunity through this to decrease the cost of heart surgery or to have an alternative to some procedures, it is obviously something that the ministry should be advocating to the federal government. The act should be changed to recognize this.

Hon. E. Cull: The province of British Columbia doesn't have the resources to do this kind of investigative work into new therapies. In fact, there has been a division of labour, if you like, between the provinces and the federal government. The federal government does the investigation. It would be very unwise of me to support any new therapy -- and I'm not just talking about this one -- when we don't have any ability here in this province through our own resources to make an analysis of its value or lack of value in treating particular conditions. That is the responsibility of the federal government. It has a well-developed process, and we rely upon it to approve new technologies and procedures.

L. Fox: I have one more question with respect to that. Perhaps the minister can tell me whether or not this is presently being considered by the federal government. If so, what stage is it at?

Hon. E. Cull: I'm sorry. I don't know where the federal government is with this, but I'd be happy to get back to the member.

L. Fox: I have a couple of specifics. One is with respect to Omineca Lodge intermediate-care facility in Vanderhoof. I've been told by the administration and the board members that dollars have been applied for through the ministry to upgrade that facility. It certainly is in need of it. Can the minister tell me whether or not the ministry officials here have any knowledge of what process or where it's at within that process?

[ Page 3232 ]

Hon. E. Cull: One of the difficulties in dealing with the Health estimates is that there are literally hundreds of facilities which may have made application to the ministry or may be somewhere in the five-year capital plan. I certainly don't have the full, up-to-date listing of them all here with me, and the staff I have here with me today don't. Again, with respect to Omineca Lodge in Vanderhoof, I've made a note. We'll let you know where that one is in the process.

L. Fox: Another concern that's been identified to me by medical people, pretty much provincewide, has been whether or not the walk-in clinics are of value. I can say, in all honesty, they only point at it as to whether or not any kind of assessment has been made, given some concerns from some medical doctors who see it as being a referral service and a prescription-writing service rather than a real, legitimate medical service.

I have a couple of questions with respect to that. What are the costs of those walk-in clinics to our medical system provincewide? Are we doing any evaluation of that process to see whether or not those dollars might not be better spent elsewhere in the budget?

[5:30]

Hon. E. Cull: The cost of the walk-in clinic is essentially the same as if you saw your doctor. There's no differential in fee, so the costs that would be attributed to walk-in clinics would mean adding up the number of services that have been provided and the various fees that are provided for those services. But I share the concern. In many cases it appears that people go to walk-in clinics only to go to their doctor the next day or the day after on the very same condition. It is something that we are looking at in terms of trying to evaluate whether they do provide a real, additional value in terms of health care. Other provinces have been looking at this issue and have brought in differential fee schedules, I believe. I think I'm correct when I say Ontario has done that; if they have not done that, then they are considering doing it.

The other one is dial-a-doctor, where you can phone a doctor who is on call all the time to come to your house and treat you. That is another area we're looking at.

L. Fox: I take it from the minister's statement that walk-in clinics are not a separate item within the budget, and that they're mixed in with the total budget in the fee-for-service area. Can the minister perhaps inform me how many doctors we have employed in walk-in clinics? If we can't identify those two things, I wonder what process we will use to evaluate whether or not it's effective in terms of a cost-benefit analysis.

Hon. E. Cull: That's one of the things that we need the tools of Bill 71 to be able to get at. We need to be able to audit practitioners to see whether their pattern of practice is wildly beyond the norm. We also need to be able to look at patient behaviour and see whether a patient is seeing two or more doctors for the same condition within the same period of time -- beyond the second opinion that one might normally expect.

We don't know about the number of doctors in the clinics because they are all fee-for-service practitioners. There is not a separate category for walk-in clinics. But we are able to look at the services, and we can take the records -- once we have audit provisions -- of a walk-in clinic and look at the kinds of work they're doing there and satisfy ourselves as to whether they're providing an additional health care benefit to this province that's of value.

L. Fox: I'm really trying to grab hold of what the walk-in clinic system is, as I've only recently been exposed to it. How many walk-in clinics do we have in the province of British Columbia?

Hon. E. Cull: We only have records of physicians who are enrolled in the plan. Whether they operate out of their office, in cooperation with a number of other doctors in a group practice or in a walk-in clinic, there is no separate identification of the location of their practice. It is the nature of their practice that we have information on, and that is the only way we can track them at this point.

L. Fox: I'll leave that item then. Obviously we don't have a separate delineation of the exact impact of the cost for the clinics.

Another question I have to ask, given the headlines which said the report urged a means test for Pharmacare, and so on.... Obviously there was some difference of opinion between the minister and the Premier with respect to the Pharmacare study done under the previous administration. Can the minister tell me and this House exactly what the status of that study is, and whether or not it is going to be utilized by her ministry?

Hon. E. Cull: A Pharmacare review committee was established under the former government. As I understand it, it's a sort of a continuing standing committee, as opposed to a committee that just had a task to do. I don't have all the dates in my head, I'm afraid. It was asked at least a year and a half ago to do an evaluation of Pharmacare. The report was completed last year. It sat around for a while. The people who worked on it were anxious to see it reach the light of day, because they had spent a lot of time doing it.

My position on reports in the ministry is that wherever possible, they should be made public. I made the report public. We are looking at it. We do not have any ownership of it, since we did not commission it, but there are some suggestions in it which may be worthy of further study. At this point, we're having a look at it in the way the ministry typically looks at all kinds of reports every day.

L. Fox: One other procedure I'd like to inquire about is whether or not there has been anything further from this government and your ministry regarding acupuncture. I understand that's very similar to the chelation issue. Is it also being held up by the federal govern-

[ Page 3233 ]

ment, with respect to being recognized by the provincial government? Or is there some other issue there which doesn't allow us to recognize acupuncture as a legitimate form of health treatment?

Hon. E. Cull: I believe the Acupuncture Association actually has an application before the Health Professions Council to become licensed as a self-regulating profession under the council. The council will be making a determination on that in due course; they have a process they go through. The provide a recommendation to me, and I expect to receive it when they have had a chance to go through the procedures they would normally go through.

L. Fox: Perhaps I shouldn't be asking this question; I should have done the research in order to find out myself. Could the minister enlighten me as to who makes up this council and what the structure is?

Hon. E. Cull: Off the top of my head, I don't have the names of the individuals. Three people were appointed by the former Minister of Health, John Jansen. I've met with those individuals, and they seem to be a very dedicated and hard-working group that is doing a very good job. They are Irvine Epstein, who is a lawyer; Arminee Kazanjian -- I'm not sure I pronounced that right; my apologies to her -- who is with the Centre for Health Services and Policy Research at UBC; and David MacAulay, who I believe was an administrator for the Chilliwack School District.

L. Fox: I'm hopping all over the place, and I hope that's acceptable, hon. Chairman.

Earlier this year the minister initiated the hepatitis B immunization program. Can the minister inform me how many cases of hepatitis B were identified in the province and what precipitated this particular program? It wasn't contained within your news release.

Hon. E. Cull: Again, I don't have that information with me here tonight. But I've made a note of it, and we'll get back to you.

R. Neufeld: Just a few brief questions to the minister. She may have answered some of these before, I'm not sure. They have to do with attracting doctors to the north and what we can do to try and keep them there. One part of the Seaton report that bothered me and a lot of people in the north was not allowing foreign doctors into British Columbia any more. That is our greatest draw of doctors for the north, because we can't seem to get them out of the lower mainland, off Vancouver Island and into the north. They usually come from overseas. Specifically in Fort Nelson we have a real problem. We're fortunate to have had one doctor who has been there for a long time, but this fellow is going to retire at some point in time, and I'm afraid that the community is going to be left short. If we don't allow the bringing in of those doctors, the people up there are going to be without services. It's 250 miles from Fort Nelson to Fort St. John, which is quite a little jaunt. In fact, we have been short enough at different times when pregnant mothers had to be flown out to Fort St. John specifically to deliver babies. I'd just like to know if there's anything planned whereby we can recruit doctors to stay in the north a little longer.

Hon. E. Cull: The member is correct. I actually gave an extensive answer to this question one evening last week at the beginning of my estimates. I believe, in fact, that it was this member who asked some question.... It might have been him or his colleague. He wasn't in the House when I gave the answer, but if he checks the record he will see that I spent some minutes going over a wide variety of programs that we use to encourage physicians and other health care practitioners into parts of the province where they have been less than willing to go. I mention it very quickly here, but I do encourage him to look at the answer: the northern and isolation allowance program, the northern and isolation travel assistance program, the subsidized physicians program, special contracts, some direct contracting of nurse practitioners, the UBC psychiatric outreach program, a program that provides specialists, a travelling specialist program to the north. I'm just trying to see if I've missed anything here. There is the development of rural residency programs. I encourage the member to have a look at the fuller response that I gave the other evening.

R. Neufeld: I will, and I apologize for that, but it wasn't me that asked the question. I can guarantee that.

The other question I have is on a travel allowance for people to come to the lower mainland for specific services. I proposed some way to help do that by ourselves and by our government employees, and I wonder if the minister would give me a brief response on this, or is there another travel program that she is initiating?

Hon. E. Cull: Again I encourage the member to have a look at the record. It was extensively canvassed the other night. The member for Prince George North -- when in opposition -- was a champion of bringing in travel assistance to northerners so that they could travel to Vancouver or other places to get necessary treatment. We have had a look at the cost of the program for this budget year. The program that had been developed by staff -- under the former government some work may have been done on costing -- was clearly inadequate for what we saw as an appropriate program this year. We are continuing to look at it, and continuing to look at catastrophic medical expenses -- whether they be travel, drugs, special equipment or ambulance services -- that may impact on people beyond what has traditionally been covered by medicare.

L. Fox: I just want to follow that up, because I asked the question about what was going to be available to encourage health care professionals to go into the north. I didn't deal specifically with doctors. However, the programs as outlined have obviously encouraged medical professionals into northern B.C. But by and large, it has been pretty much on a short-term basis. When they reach the commitment made on entering into those

[ Page 3234 ]

agreements, we've seen them move south into so-called greener pastures.

One of the concerns that I've had, and lots of northerners have had.... Obviously, when the UNBC becomes a full-fledged university, it will help us to address those concerns. But in the interim, especially in the area of medicine, the students of the north have horrendous costs to go to medical universities in the lower mainland or elsewhere in Canada.

[5:45]

With respect to teacher shortages, our respective school districts have tried to address the same issue with a program in which, on a commitment by the student to come back and teach in his or her area, the district has supplemented the educational costs through the university stages. We are not offering short-term solutions to a very serious problem, but a more long-term solution by investing in our own youth to come back into our communities and give their expertise in the field they choose. I'm wondering if the minister might consider that as an appropriate program in the field of medicine, given that UNBC will be a long time before they start turning out doctors.

Hon. E. Cull: I give my apologies to the members opposite for having the two members of the third party confused as to who asked the questions. I can't remember now, but I know I gave the answer extensively in the House and then sent a note over asking if you were satisfied with the answer and got a nod.

If you will have a look at that again, you will see that I did cover bursary programs for health care practitioners. The answer was well beyond doctors; it covered the full range. I mentioned the desire with respect to moving to the two-year licensure program for doctors, which would see us have more rural family practice. That work is going to be happening, when the university of the north is up and running, with the health care professions that were there. There's a lot in that answer, and I encourage you to have a look at it.

D. Symons: I'm just picking up on a question asked a few minutes ago by the member for Peace River North regarding travel assistance. I'd like to bring that a little closer to home, because this is a concern that was brought to me by a person just up the coast here. This person needs medical treatment and has to travel by ferry quite frequently back and forth in order to get the treatment he needs on a regular basis. He is finding the costs of the ferry travel are quite expensive for him. On top of the medical condition that needs the treatment, it is a bit of a strain on the family. I'm wondering if the minister might consider that even local travel of that sort could somehow -- through the doctor or in some manner -- be given a pass good for a certain period of time in order that this extra expense to receive treatment could be covered. A comment, please.

Hon. E. Cull: It's a good suggestion in terms of trying to look at how we can address the costs of travel for medical care. If the individual you've been talking to is on social assistance, they would receive some through that. There are passes, I understand, that are available. I share your concern that for the vast majority of people in this province who have to travel -- whether it is frequently on the ferry or, hopefully, only once in a lifetime from Prince Rupert -- and stay for many days, it can be a real financial hardship.

We have looked at it, and we are continuing to look at it. It is certainly a priority of mine in terms of trying to improve health care services, but it can't be resolved quickly this year. It couldn't be resolved in this year's budget. We will have to leave it to future work on how we might restructure insurance for catastrophic health care costs. That's where I tend to put those. Even if it's a constant ferry charge, which may not be thought of as catastrophic, over time that adds up. We're looking at trying to deal with the costs that individuals have that may put a burden on them and things that were not contemplated by medicare when it was initially put together and are probably not covered well under it right now. I think we do have some options, and we're looking at them.

D. Mitchell: I too would like to direct a question to the minister with respect to travel costs and reimbursement of such for medical care, but in this case outside the province. I wonder if I could just change gears to that topic for a second, because I know a number of cases have come forward. I'm sure all MLAs have received representation from constituents with concerns about that, especially going back earlier this year to the time of the HEU dispute.

The government made some arrangements for British Columbians requiring urgent surgery to have transportation costs covered if they left the province. I have a couple of cases that I would like to use as examples and seek the minister's response on. For instance, I had one constituent who, in February of this year, was diagnosed as having cancer in both lungs. It was recommended by her doctor at VGH to seek treatment immediately before the disease spread, but she was also advised that it might take many weeks or perhaps months before she could attain surgery here in British Columbia. This individual, largely on her own initiative, was able to arrange for surgery in Toronto. She was advised by her doctor that if she could in fact get admittance into the hospital, to do so immediately. She immediately got on a plane, went to Toronto and had the surgery. Upon her return she was advised that other patients who were facing this problem, because of the looming HEU dispute which was by that time a reality, would be able to have costs reimbursed or air ambulance service provided by the government for emergency service. I'm wondering if this kind of individual would be eligible for reimbursement of the cost of the trip to Toronto for urgent surgery, which in this case was completed.

Hon. E. Cull: I want to make sure the member is aware of the circumstances around the HEU situation that he alluded to. Two patients were transported out of province as a result of that. As it turned out, the ability was there; the hospitals were in fact able to meet the emergent and urgent needs of patients. We do pay travel costs to Calgary and Edmonton. I assume that is

[ Page 3235 ]

because people who live in the Kootenays really have closer access to hospitals there than they do to hospitals in Vancouver. We almost consider that to be a little bit of our province in that situation and provide that travel to them. As it's a problem in British Columbia with people needing to travel from remote communities into Vancouver for tertiary-level care.... We have the same problem. If that care is not available here in B.C., we do not pay for the travel outside the province, although if it has been approved by the Medical Services Commission, we certainly pay for the care. I can't comment on the specific case that you talk about, although it sounds highly unusual that that treatment would not have been available here in British Columbia. I don't have enough details to comment. It is a problem when people have to travel for care. We don't have all treatment here in this province, and we certainly won't have it all in everyone's community.

I have to say again -- as I said to the two members before you -- that we recognize it's an issue. We would like to address it. It is a matter of cost and priorities, and we're looking at ways to address it -- through cost efficiencies within the ministry and by looking at some creative ways of doing it. Other provinces have come up with some interesting ideas, and we're looking at them and will continue to work to find a program that will suit British Columbia.

D. Mitchell: I thank the minister for that response.

I'd just like to take this one stage further with this particular case, because it's one that's of some importance to me -- and obviously to a constituent of mine, who in this case happens to be from Squamish. This person can ill afford to have covered the cost, and yet it was a matter of life and death. It took place in February this year. The diagnosis was quite urgent; the cancer was spreading into both lungs. On the advice of her doctor, practising from the VGH, she was advised that if she could get the surgery done somewhere else as soon as possible she should do so. With the looming HEU strike -- at that time it wasn't a reality, but it certainly looked like it was going to be a reality -- he advised that it could be weeks, probably months, before the operation could take place here in British Columbia. In this case the patient was fortunate in that she had a brother-in-law in Toronto who was chief pathologist at a Toronto hospital. It's a complicated story, but very briefly, over the phone he was able to guarantee that if she could get onto a plane immediately, a spot could be found for her. On her own initiative she did this. It was quite a traumatic experience, as the minister will appreciate.

She had the surgery and returned to British Columbia. She has written to the Medical Services Plan. In fact, she'd written to the minister at the end of April asking if in her case she could be reimbursed for her cost. It seems to me that under the guidelines the minister has referred to, it would be reasonable to expect that perhaps her travel costs, which in this case saved her life, would be eligible for reimbursement.

I'd just like the minister to clarify. I could certainly provide further details of this to the minister. As I say, this constituent of mine has written to the minister but hasn't received a reply yet. She wrote at the end of April to the minister directly. Does it sound like this would be the kind of case that would be eligible for reimbursement under the plan?

Hon. E. Cull: This particular case sounds somewhat complicated. If the member would care to take it up with me directly -- apart from the estimates -- I can probably get him a full answer on what has happened and give him a better answer. It sounds to me more like what I call casework, where we would actually have to get in and have a look at the details. I certainly don't have that information here with me tonight.

D. Mitchell: I'll certainly do that. I'll direct this material to the minister's attention and hopefully get a response for the individual concerned.

I have one other case on the issue of reimbursement of costs for travel outside the province. In this case, another constituent of mine had been diagnosed and treated for Hodgkin's disease, including treatment at Lions Gate Hospital and the bone marrow transplant unit at VGH. In April of this year he suffered a relapse. The practising specialist who was treating him recommended a special kind of scan as soon as possible, but there was a six-month waiting-list in British Columbia for this special scan. Because it was considered critical for this person to have the scan done as soon as possible, his physician arranged for him to be booked into St. Joseph Hospital in Bellingham the following week. The important thing here is that it was considered to be critical for the scan to take place. The cost of the procedure was some $1,300 for this person to go from Squamish, in this case, to Bellingham for the scan, and I'm wondering if this kind of operation would have been eligible for reimbursement under the Medical Services Plan.

Hon. E. Cull: I assume the member is talking about MRIs -- magnetic resonance imaging. There are now three right in the province, and two more are being added. But I have to comment on the waiting-lists. There are waiting-lists for some technologies, but they are for elective use, and urgent cases usually get through very quickly. Again, when we start dealing with a particular case, it's very hard. You and I can go backwards and forwards here about it, but I would suggest that you make an arrangement to discuss it directly either with me or my staff, and we can provide you with a full answer on it.

Mr. Chair, noting the time, I would now move that the committee rise, report progress and ask leave to sit again.

The House resumed; the Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. G. Clark: I move the House recess for five minutes and sit no later than 11 p.m. this evening.

[ Page 3236 ]

Motion approved.

The House recessed at 6 p.m.

The House resumed at 6:07 p.m.

Hon. G. Clark: I call Committee of Supply.

The House in Committee of Supply B; D. Streifel in the chair.

ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS

On vote 48: minister's office, $365,941 (continued).

Hon. G. Clark: If I could take this indulgence, I would advise the House that we'll go until roughly 7 o'clock. Then we'll break for other business for an hour and come back to these estimates.

D. Mitchell: Before we had the brief adjournment, I was discussing the payment of costs for out-of-province medical care, especially where it's an emergency. The minister indicated that during the Hospital Employees' Union strike there were a couple of incidents where British Columbians were transported out of the province, and their costs were reimbursed to them. There was a case where MRI, magnetic resonance imaging, was required to be done. This was a case that was not during the HEU dispute, but where somebody was required to go, on the advice of a physician, to Bellingham to get that done. This individual, who is a constituent of mine, thought that it was ironic that MSP would be willing to pay for B.C. residents to be treated outside of the province during a labour dispute but would not pay for the treatment that is considered to be an emergency if it isn't readily available in British Columbia. Could the minister clarify what the policy is on that and whether this constituent of mine might be eligible to seek reimbursement?

Hon. E. Cull: During the labour dispute it was a highly unusual situation. Towards the end of that three-week dispute the chiefs of medical staff and the hospital CEOs began to advise me that they were concerned that essential services designations were not going to allow them to provide emergency health care and that extremely urgent health care had to be provided if it wasn't to become an emergency. Because of the advice that that might be happening, we made that offer. Certainly in the case of urgent and emergency care, you don't have a lot of time to wait. Generally when we have full services as opposed to essential services, which are somewhat lesser, all emergency and urgent care is accommodated within this province, because waiting-lists occur not for emergency care but for elective care. Again, given the specifics of that particular constituent, I would be glad to investigate for the member.

D. Mitchell: I will pass this on to her in writing as well.

I guess there is some confusion on the part of many, including myself, as to what constitutes an emergency. If a physician writes a letter on behalf of a patient indicating that it is serious and an emergency, it's critical that surgery be completed as soon as possible. But if there is a six-month waiting-list for that service within the province, then there's certainly a question in the mind of the patient, who is obviously undergoing some trauma, and certainly a question in my mind as to what the definition of an emergency is. Could the minister clarify that, especially as it pertains to travel outside the province and reimbursement of costs?

Hon. E. Cull: I can't give a definitive definition of what is an emergency, urgent and not, but clearly the wait-lists exist for elective treatment. If it's an elective procedure, people can wait a bit longer; emergency and urgent ones always bump to the head of the list. If the specialist, or the radiologist in this case, agreed with the referring physician that this was urgent, it should have been dealt with at the top of the list here in this province. Again, we've got to get to the specifics. I'll look forward to receiving your letter.

D. Mitchell: On the issue of community-based health care, which we have been canvassing for a while, although we got off topic with a few issues, could the minister inform the committee as to the role of pharmacists in delivering community-based health care? During the year ahead that the minister is going to be spending the moneys that we're being asked to approve, she has indicated that she wants to take some initiatives that are geared towards delivery of services closer to the communities and the people. Is there a specific role that the pharmacists of British Columbia will be playing within that plan?

Hon. E. Cull: The pharmacists are obviously a very important part of the health care team and are employed in hospitals and in private businesses. They are in a position, I think, to work very closely with our ideas about community-based care. Pharmacists will and should talk to people about their prescriptions and about other conditions in their lifestyle -- other prescriptions they might have which would affect the medication they are taking, and their overall health. I think they could be a very effective and very important part of community-based care.

D. Mitchell: I, too, think that pharmacists could play a role in a system of health care that is focused on the community. There is probably a role for the pharmacists' association of British Columbia to play in that. But I have a concern that's been brought to my attention by a constituent which deals with the fact that pharmacists, while I guess they can be regarded as health care professionals, are also business people. This concern was brought to my attention by a member of an association that I think is a very important one, the Vancouver Breastfeeding Centre. As the minister well knows, the Vancouver Breastfeeding Centre does some very good work in promoting breast-feeding among mothers as a way of promoting health for newborn

[ Page 3237 ]

infants -- throughout their life, in fact -- as well as for the mothers themselves. Yet there are apparently some pharmacists who are promoting the use of formula, from a marketing standpoint, for some manufacturers of formula. This goes against the recommendations of the World Health Organization, which has developed a code of marketing for breast-milk substitutes.

The minister, I am sure, will be aware of the sometimes very negative practice in Third World countries of promoting formula-feeding of infants as opposed to using mothers' milk. But here in British Columbia we have a problem as well where customers are encouraged to take advantage of free gift packs from pharmacists and through other private organizations to encourage mothers to feed their children formula as opposed to breast milk. I wonder if the minister would have any comments with respect to that, whether her ministry is taking any initiatives in this area and whether the Vancouver Breastfeeding Centre can expect some assistance from the ministry in terms of delivering the service they do.

[6:15]

Hon. E. Cull: I'm not aware of any pharmacists encouraging formula over breast-feeding per se, although certainly some pharmacies may be promoting a product or making it available. Unfortunately, I think there are still some hospitals in the province which do have formula samples in the kits or packages of products made available to new mothers. But if this is a concern about pharmacists as a professional organization making this recommendation, I would be most happy to take it up with the pharmacists' association on behalf of the member and the Vancouver Breastfeeding Centre.

D. Mitchell: Just for the minister's information, it is an issue, apparently. At least two of the major pharmacy chains in British Columbia are offering formula gift packs free to new mothers.

Hon. E. Cull: Is that "pharmacy" or "pharmacist?"

D. Mitchell: Chains of drugstores are offering these. For instance, one drugstore was offering a promotion of $100 worth of coupons and a free gift to new mothers. What is the free gift? It's a box marked "For the Breast-feeding Mother," and it's from the makers of a formula. What's inside the box? It's a package of formula, formula information and a video that is very biased in favour of using formula as opposed to breast-feeding. So these are the kinds of free gifts that are being offered, and they're being distributed through at least two major chains in British Columbia.

I'll mention just one other example for the benefit of the minister. There has been a dramatic increase in the cost of formula. But apparently the Grace Hospital received a $0.5 million gift in exchange for an inclusive contract to provide free formula to mothers coming in to deliver their infants at Grace Hospital.

This is an issue in British Columbia. I think it's important for the government to take a leadership role, and it's important to recognize the terrific work being done by the volunteers at the Vancouver Breastfeeding Centre, who are encouraging wellness in a very positive way. I wonder if the minister would have a response to those kinds of initiatives.

Hon. E. Cull: I commend the member for his support of breast milk as the food of choice for new infants. When you talk about pharmacy chains, I have to caution the member that my talking to the College of Pharmacists will not necessarily have an impact there. I assume that the pharmacists who work in these chains are not the owners of the stores. Therefore, while their owner or their chain may be promoting infant formula, I would assume that they as a professionals standing behind the counter or working at the back as an employee are not personally involved in that promotion. I would be surprised to hear that.

When hospitals receive formula, my understanding is that for the most part they use it very sparingly. There are cases, of course, where infants do have to be formula fed. But I will raise the matter with the College of Pharmacists to satisfy myself that pharmacists are not participating in encouraging mothers not to breast-feed.

D. Mitchell: I appreciate those words from the minister. It must be recognized that women who are trying to breast-feed should be encouraged to do so rather than receiving messages from whatever source -- whether it be through pharmacies or other sources -- that they need to use formula supplements in addition to breast-feeding. If the minister could provide some leadership and direction on that, I think it could be a very positive thing.

I'd like to just ask the minister one other question with respect to an issue that's been raised again in my constituency: Lyme disease, or the more correct term, I believe, is borreliosis. This is a disease that is contracted through ticks. Of course, it can be a serious issue in any forested area, which is most of British Columbia. I know that there was a working group in the Ministry of Health taking a look at the disease. There was a Lyme disease working group and a referral clinic as well. Could the minister update the committee on the status of that working group and referral clinic?

Hon. E. Cull: I know that there is some work being done on this. I don't have the briefing note here in front of me. I assume that if we are patient, I'll have one sent to me fairly soon and will be able to answer that question.

D. Mitchell: I do have a couple of questions on this. It's a topic of some interest to me. Would the minister prefer that I asked the questions right now?

Interjection.

D. Mitchell: The issue goes back to November 1989. Apparently the Ministry of Health established a

[ Page 3238 ]

borreliosis working group, which was coordinated by the British Columbia Centre for Disease Control. The group's mandate was to conduct research on Lyme disease, or Lyme-like diseases, and provide the public and medical practitioners with up-to-date information. The issue here is that Lyme disease is not very well understood, and what might be diagnosed as Lyme disease might not be the disease at all. In fact, there are some theories that there is a whole range of diseases out there that may have been diagnosed incorrectly. I don't want to name them all.

Recently there was a report from the British Columbia Lyme disease project which was reviewed by an independent scientific body and publicly released. I'd like to find out the status of the review of that report. Of the money that was allocated to the Lyme disease referral clinic and project over the last period, how much was not used? Is the funding currently being used? Have there been any results? Those are the questions I would like to direct to the minister.

One other thing. Apparently one of the early objectives of this working group within the ministry was to provide the public with up-to-date information on the prevention and treatment of Lyme disease and other tick-related diseases, which anyone walking in the forests of British Columbia could contract. I wonder if there is any work currently being done to inform people of the dangers and risks of that disease, because that was one of the mandates of the working group.

Finally, I'd like to know if the minister and the researchers at the B.C. Centre for Disease Control are aware of the recent discovery at Yale University which has received some media attention particularly in the United States. It is the discovery of a possible vaccine for Lyme disease. Are researchers in British Columbia making any efforts to share information with researchers in other countries who are also looking into Lyme disease?

This is an issue of some concern, because if Lyme disease is what we believe it to be -- related to ticks that are prevalent in our forests -- then it would be important to advise British Columbians of that and to be cognizant of research being done elsewhere. So it's a research-related question, and I would certainly appreciate the minister's responses to those questions.

V. Anderson: Before I go on to another topic, I'd like to follow up a little on the questions that we were discussing the other day regarding a couple of the youth alcohol and drug treatment programs. In following that up and in some contacts I had today, I have been told that the board of Impact has decided to close down their program because they do not have the funds to maintain it. This leaves 30 teenagers between 13 and 19 without the ongoing treatment they have been engaged in. There were another 30 on the waiting-list for that program.

I'm wondering if you're able to give some help to the parents and families of these youngsters as to where they might be referred and who will pick up these kinds of programs, and particularly these 30 to 60 youngsters, who as of Wednesday will be without the programs that were treating their needs over the last number of years.

Hon. E. Cull: We canvassed this one the other night. As the member knows, Impact has not received funding from the ministry before, so this isn't a question of their funding being reduced. There is, I understand, another group that we do fund in the Abbotsford area, and I would assume that these youngsters would be referred to that group.

As the member knows full well, the community is contemplating right now the spending of $54,000 on the particular area that's he's identified. Because we believe in communities making decisions, we're leaving that in the hands of the community to conclude where they think the money can best be spent. I'm sure that the local people in that community are fully aware of Impact's decision to close their facility and will act accordingly.

V. Anderson: Just one other question in that area. It has to do with the assessment treatment centre that was operating through Peak House, which received students throughout the province. They still have the treatment centre, but I was wondering where other assessment centres are in the province that these youngsters might be referred to. There are inquiries, and they would be interested in where these youngsters could be referred to at this time -- trusting that there are facilities in place before others are discontinued.

Hon. E. Cull: There are referral services. Again, we did discuss this the other night, Mr. Member. There are other referral services in all of the five regions of the province which alcohol and drug programs use for their administrative purposes. There is a belief in the community that one does not need to have residential assessment and that assessment can take place through a variety of services that are provided. I don't have the details of each one, but as I said the other night, there is supportive, or safe, housing in each case for these youngsters who are being assessed, and appropriate professional services to do the assessment.

V. Anderson: I'd like to move into another area of community care. This has to do with small hospitals where there is one doctor serving an area, and when that doctor goes away for study, leave, or for holidays, there's no medical doctor. The practice has been to bring people on locum. It's my understanding that over a number of years it's been very difficult to find persons registered in the province who are available to do a locum. There are persons who are registered in other provinces in Canada and some overseas, but it takes so long to get those people to come to British Columbia that they're just not available. Is there a process in place to make it easier for locums to be discovered, and to be brought in to meet these needs over a short-term basis?

Hon. E. Cull: Mr. Chair, I'm not aware that there's a problem with finding a locum, although the member may be bringing new information to my attention. But the question of who can practise medicine in this

[ Page 3239 ]

province is a matter that the College of Physicians and Surgeons of B.C. is responsible for. They determine who can practise, not the Minister of Health.

V. Anderson: Community health care in our own community has a large bit to do with seniors who are living in a variety of facilities. As you're probably aware, at the moment there is a long waiting-list for persons who have need of care. The difficulty is that many seniors don't feel that they should apply for the care two or three years before they need it, so when the need for care suddenly comes upon them, the facilities are not available. Is there a plan? Or is there some way of advising seniors to give them some sense of direction for this program, both in varieties of care and how they can make plans ahead of time?

Hon. E. Cull: The area that is represented by the member generally is one of the areas of concern in the province. I talk about that in the broad sense of your region, the Fraser Valley, which has been one of the fastest-growing parts of British Columbia. We are struggling to catch up there, not only with population growth but with the inadequate funding that had been provided by the previous government. This year we have made significant increases; I cited the figures earlier in the estimates in terms of percentage and dollar increases to services for seniors.

We are trying to address those waiting-lists essentially in two broad areas: one is to provide increased services to seniors to help them maintain their independence and live in their own homes as long as is possible; and the second is to increase the number of long-term beds by, I believe, 500 this year.

[6:30]

V. Anderson: If I might follow that up with a specific illustration that is typical of others that I know of.... A person was widowed and had her own home; it was paid for. She was able to live in her home, but because she needed 24-hour live-in care, particularly in the evening in case she fell and needed some help around the house, she wasn't able to afford to maintain somebody in the house even with the subsidies that were available to her. In order to survive, she was forced to sell her house. Having sold her house, she had the money to look after herself, but she couldn't do it as long as she had the house. She was caught in that kind of bind. The independence could have been there, but she couldn't afford to live in her house; and if she sold it, she no longer had the opportunity for that care.

Hon. E. Cull: There's always a point at which it does make sense to move people from community care to institution-based care, and that's based on the needs of the individual and the costs of providing care in each place. We have provided significant increases to both home-based care and community-based care, directly targeted to the issues that you're raising. Despite the fact that the overall increase in community health care funding this year is in the order of 25 percent, it's still not going to be enough, so we have made a priority shift to move that money. But we recognize that this is a beginning, not the end of working on the solution.

There are a number of things that the individual you cited could have considered, including some of the very creative programs available around reverse mortgages which would have allowed her to stay in place but also have adequate income to buy care. But I assume there comes a point -- and maybe it did with this particular individual -- where it made, in balance, more sense for her to move.

V. Anderson: One of the other major concerns in the surveys and in the discussions with seniors and persons approaching that is the same concern that many people with handicaps have. They could live in their accommodation but for the question of transportation -- of getting out to doctors, social events, church and whatever other things that are very important in their lives. It may not be directly under this minister, but is there some cooperation in making home-based transportation available? The bus system that they now have, which they can order periodically a week or two weeks in advance, is helpful but doesn't really meet the ongoing needs to socialize, to be a part of the community and to get out and have the opportunity to continue their active lives, which is very important for them.

Hon. E. Cull: With respect to services provided through B.C. Transit, I suggest the member take it directly to that minister, but with respect to community-based services, most of the ones that I'm familiar with do have a transportation component to their services. They have buses, vans and other ways of transporting people back and forth.

V. Anderson: I'll follow that up. I realize about B.C. Transit. But it seems to me that if we're encouraging people to live in their homes, then there needs to be some cooperation between the Health ministry and B.C. Transit, if you like. Many of these people are not anxious to be going to "the programs" that are run for seniors -- institutional programs -- but would like to be able to get out and visit their family and friends, and they're just not able to. I guess what I'm asking is: what kind of cooperative discussion is going on between the independence programs of the Health department and B.C. Transit so they can be supportive of each other in meeting the needs of this very large part of our population?

Hon. E. Cull: The broad issue of public transit is one that's of concern to the government and which we are working hard on through a number of avenues to improve access to public transit, within the ability to do that this year.

On the particular matter of seniors, the council for seniors, which we talked about a bit the other night, is looking at the particular aspect of transportation. It's more of a problem outside urban areas than it is within urban areas where there is ready access to public transit in most cases. They are looking at it as one of their priority issues, and I look forward to hearing their ideas on it.

[ Page 3240 ]

V. Anderson: With regard to that area of transit, it comes up in one form in urban areas, but it also comes up in another form in the rural areas where, particularly in the north, people have raised the concern that during the summertime they be able to get out and get around. Once the snow or even the ice comes, and they're homebound and no longer able to get around, what is the program of independence that can support them during what to them is a long period of the year -- six to eight months?

Hon. E. Cull: The difficult conditions that exist in parts of the province during the winter months are of concern not only to seniors, but to disabled people and others who find it difficult to get around, such as poor people who may not have cars for travel. It's a widespread problem that we can't solve directly through the Ministry of Health or even through the Minister Responsible for Seniors. When we are putting in place community-based services, we design them in such a way as to recognize that either the service has to travel to the people in their homes, or the people have to be able to move to where the service is. What will work here in Victoria, when all you have to worry about is getting around in a wet winter, will obviously not work in Prince George, where you have to also consider that people may have to deal with snow and ice and rather terrible conditions in the winter.

We're not developing a community-based model that suits just one part of the province. The great reliance on the communities themselves to develop the programs will ensure that they are climatically and geographically appropriate as well as the other things that we're concerned about.

D. Symons: Just one brief question here dealing with a letter I received -- and I'm sure you have a copy also -- from the Canadian Deaf-Blind and Rubella Association. They were seeking a response from the government and hoping for funding to provide a summer intervention program. I believe this has gone on before, but they're about to receive approximately half of what they need for this program. The program has been in cooperation with the Ministry of Social Services, the Ministry of Health and the Ministry of Education. It seems that they're not going to get enough to go ahead this year with the program that really does two things. During the summer when the special schools where these children receive proper training..... It keeps up that training, and it keeps their skills and communication -- signing and other things -- there for them so that they're not left to fall back to previous levels and lose some of the learning that has taken place during the school year.

On the other hand, what it also does -- which isn't mentioned in the article that I received with this -- is to give the parents the opportunity for a bit of relief from the strains of raising children who have these special needs. This is certainly important to the health of the family. I have, unfortunately, a very good friend who had two autistic children. I believe the strain on that family in raising those children had more to do with the family breakup than anything else. That same situation could be true of children who are deaf or blind. We had neighbours, as a matter fact, whose child was born deaf as a result of rubella. We could see, within the neighbourhood, the difficulties the family and the child had in communicating and being a part of that community.

It's a small figure as far as money goes. I'm just wondering why it's not possible through those three ministries to somehow supply the full funding so that this vital program could be carried forth to help these children and the families involved.

Hon. E. Cull: It sounds like a very good program; I don't know it specifically. You say there are three ministries involved. I can't answer tonight on the other two ministries' involvement in this. But I've made a note of it here, and I'd be happy to get back to you and let you know what the situation is and the status of their funding request.

D. Symons: Just for information, I would be pleased to give a copy of the letter to the minister.

L. Reid: To the Chair, is there a quorum when the House is in committee?

The Chair: The requirement for a quorum is the same in committee as in the House as a whole.

L. Reid: It seems to me that we are well short of the required quorum. I will proceed only when a quorum is present.

[Call for quorum.]

The Chair: There now being a quorum, the hon. member for Richmond East.

L. Reid: My next questions will pertain to the issue of kidney dialysis. Kidney dialysis in the province, as anywhere else on this planet, is typically done three times a week for a minimum of four hours at a time. I understand that we are allocating additional dollars to the delivery of kidney dialysis. I would be most interested in how that breaks down and specifically in the increased number of patients over the current delivery system, because the current delivery system is not adequate.

Hon. E. Cull: My staff is looking up the answer to those very specific questions. I would appreciate it if the member would go on to another question.

[6:45]

L. Reid: My interest in kidney dialysis has come to the fore right now as a result of a number of letters I have received in my constituency office as the official opposition Health critic. For individuals who live in different parts of this province and are unable to visit family, travel to conferences, go on cruises -- that sort of quality-of-lifestyle choice -- because there simply is no kidney dialysis available at their destination, that is

[ Page 3241 ]

a concern. I put forward this concern to the Minister of Tourism some weeks back. I have yet to receive a reply.

In my view, the issue is discrimination. We've simply said to people who live outside of the lower mainland that that is where they must stay, because we cannot guarantee them kidney dialysis once they enter the lower mainland. That is an unacceptable notion, because we are separating families. We're saying: "Well, it's unfortunate that you live in Prince George and that your daughter, who just had a new baby, lives in the lower mainland. We cannot provide you with dialysis if you choose to visit." It is incredibly restrictive, because that allows them a day and a half to visit before they must return home to receive dialysis, which is regularly scheduled and must be available at their destination. Otherwise they cannot travel.

Hon. E. Cull: I appreciate the comments that the member has made that when you travel, you have difficulty finding space to have kidney dialysis. The difficulty is that people don't all travel from one place to another. If there was a single destination, we'd perhaps be able to provide some kind of excess capacity if we had the resources to do so. People travel all over the place, and we are unable to provide excess capacity in all communities to meet the travelling needs of the public. It's unfortunate, but it is a question of trying to establish priorities around health care funding. Short of throwing more money at the problem or increasing budgets, we don't have a ready solution to that.

We have provided more money for kidney dialysis this year. I have the figures in front of me for the community kidney dialysis services. The budget this year is $14 million, but I don't have the budget for last year. I don't quickly have the information here about what the increase is, but increased funding has been provided through both the hospital and community programs to try to expand the number of chairs available.

With the community funding, it's to provide more self-care, to train more people to be able to do it themselves. We're working with some hospitals in the lower mainland. We're currently taking steps to overcome some of the problems that exist in the Vancouver area. Extra funding and equipment is being provided to St. Paul's Hospital and to the Royal Columbian Hospital. The clinics are being expanded, and bigger clinics, such as the one in Abbotsford, are being reconstructed.

It's an area that has been brought to my attention for some time now. I hope that before too long I'll actually have the dollar figure in front of me to show you that we have taken it very seriously this year and have provided additional funding. But the travel one remains elusive to us in terms of a solution. I appreciate what you're saying about quality of life, but people don't only come from isolated communities or from other parts of the province to Vancouver; they travel all over. We just don't have the ability at this time to have excess capacity in all communities to meet the needs of the travelling public.

L. Reid: To continue with this line of questioning, I would be most interested in the amount of dollars allocated throughout this province. I made the point -- and you responded to it -- that a number of folks are travelling to the lower mainland for service. Assuming that these are family issues and lifestyle choices, I can assume that a number of these individuals are also travelling to various parts of the province. Do we have a regional breakdown of how the dollars for dialysis are disbursed?

Hon. E. Cull: Unfortunately, the breakdown for hospital funding is not available on that basis, because, as you know, we provide hospital funding on a global basis. So I'm not able to disaggregate the dollars that each hospital that provides kidney dialysis services spends on it. At a later date I could perhaps provide you with a list of hospitals where that service is available, and I can give you the information on the community-based services. But we wouldn't be able to break out the dollars for the hospital budgets.

L. Reid: I appreciate your comments about the difficulty of separating out the dollars from the hospital budgets. Would I be posing the same difficulty in asking for the dollars that are allocated for community care? Would it be possible for you to tell me if kidney dialysis is allocated on a regional basis across this province?

Hon. E. Cull: I don't have the regional breakdowns, but it has gone from about $9 million last year to, as I just said, over $14 million for this year. So there has been a considerable increase in the community and family health portion of this service.

I'm just going to give you some of the details. Special equipment for the elderly and the sight-impaired has been provided, so that they can treat themselves at home rather than having to go to a hospital. Operation of the Surrey self-care clinic has been extended to six days per week, accommodating seven new patients, and five new nurses have been hired for self-care. Work has been done on the criteria that encourage patients to go into self-care, and a number of other things have been done to improve this service. All five major programs within the kidney dialysis and medical supply services have experienced significant growth over the past year.

L. Reid: For clarification, minister, if I understand correctly, the increase of $9 million to $14 million is in the area of community care.

Interjection.

L. Reid: I appreciate the answer. My concern in terms of community care is to know if that is disbursed widely throughout the province. However, if you can come back to me at some point with the actual breakdown.... I know you've mentioned Abbotsford and Surrey. I'd be most interested to know how much further into the reaches of this province those dollars extend.

The second part of this question refers to the services that appear to be available for non-residents of British Columbia at what I believe is the kidney dialysis

[ Page 3242 ]

travellers' clinic. If we are discriminating against residents of British Columbia -- i.e., they cannot receive the service at the travellers' clinic, even though the service is not priced any higher than what we'd be paying in a hospital -- is there any reason for us to be treating residents of this province differently than visitors to this province. and if so, what is it? Visitors seem to have greater latitude in securing that service from Travellers Dialysis Clinic.

Hon. E. Cull: We do not treat our own residents any differently than we treat visitors. Visitors who come into this province may either pay, themselves, to go to the travellers' clinic, or they may have coverage through their own provincial program that would pay the cost. But we do not treat residents and visitors any differently with respect to British Columbia.

L. Reid: For my own clarification -- and certainly I will follow through with your wisdom on this matter -- it has been suggested to me that if you are a resident of British Columbia, you cannot at this time avail yourself of the services provided by Travellers Dialysis Clinic if you are not able to secure service at a British Columbia hospital. That, in fact, is a difference. You can only be treated at this Travellers Dialysis Clinic if you are a non-resident of British Columbia.

Hon. E. Cull: The confusion arises because some people who come from out of province will pay for their own treatment, or their provincial health care programs may cover that service when they travel out of province. I can't be responsible for ensuring that people in British Columbia are treated exactly the same as other provinces, because health care plans differ. Residents of British Columbia who travel to another province may be able to have their drugs covered under the Pharmacare program, whereas if people come to British Columbia.... I don't know which provinces don't have pharmacare programs, but they don't all have them, and if residents from another province came to British Columbia and purchased drugs here, they wouldn't be covered. We're comparing provincial plans in that respect, or the ability of people to decide to pay on their own.

If you live in British Columbia, we provide our health care services not through private clinics but through publicly funded facilities. To the best of my knowledge, no one who requires kidney dialysis is unable to receive it through a publicly funded facility. The difficulty is for the travelling public, which I do acknowledge, and I have said that it's a much larger problem than just the travellers' clinic.

L. Reid: I would propose the following scenario for clarification. Let's say for the purposes of this discussion that I'm a resident of Prince George. I wish to visit in the lower mainland. I'm not able to secure an appointment at a lower mainland hospital for kidney dialysis, yet I can secure an appointment at the kidney dialysis clinic for the same cost to the British Columbia taxpayer and for the same cost to the medical system in this province. As it stands, my understanding is that I would be denied that service as a resident of British Columbia for exactly the same cost, yet if I were a resident of Alberta, for example, I could acquire that service at the clinic and there would be no questions asked.

Hon. E. Cull: It's incorrect. Both the Prince George resident and the Alberta resident would have to pay if they went to the travellers' clinic. They would be in exactly the same situation, so there is no discrimination there. I don't know what the Alberta health care plan covers, but if Alberta did cover that service for their residents travelling out of province then they might be able to be reimbursed. Again, that's comparing two provincial plans. I turn it back on you, though, to say that the family that's going the other way, travelling to Prince George to visit their relatives in similar circumstances, is treated no differently. They have to make arrangements with the hospitals there if they need kidney dialysis; or if they are fortunate enough to be able to do the self-dialysis, they have those arrangements.

L. Reid: I appreciate the comments, hon. minister. I think where we are headed with this is that at some point there probably will be travellers' dialysis clinics in Prince George and other parts around this province.

The issue is not the one that is currently in operation. I would submit to you that in fact there is discrimination, because other provinces can bill directly -- e.g., Alberta. If I were to receive service, I would not pay cash for that service at Travellers Dialysis Clinic; they would bill the Alberta medical plan that is in operation. As it currently stands, if I come from Prince George, as it currently stands, I am discriminated against if I need dialysis service and I'm not able to secure it at a hospital in the lower mainland.

There is a larger philosophical issue here. It is not the kind of service you require annually or once every three or four years; it's three times a week. I believe what we are doing by refusing to look at another area that may provide the service is restricting people from travelling around this province. Our hospitals, as it stands today, are not sufficient in terms of providing the resources. I'm not convinced that the additional dollars will continue to allow this service to grow at the rate it's growing. Let's be realistic about this. People with kidney dialysis have very, very real needs. It's not something you can maybe have this week and not have next week. It is a very set regimen of clinical intervention. I don't think we're going to discuss the merits of kidney dialysis. If somebody suggests you need it, you absolutely need it. In this case, my original point -- and I'm standing by it -- is that if you're a resident of this province, you are discriminated against because your provincial medical plan cannot pay for a service that costs exactly the same whether it is performed in St. Paul's Hospital or across the street in a clinic.

My point to you and question, in terms of some justification, is: why is that so? If it is not costing the program, the province, any more dollars to provide that service in a clinic, should we not be providing it in the best interest of British Columbians?

[ Page 3243 ]

Hon. E. Cull: Once again, I point out to the member that in comparing the Albertan to the Prince George resident, she is comparing programs that are not covered by medicare, that are under the sort of additional plans that we have. I daresay that we could take another set of comparisons in another province where a British Columbian would be covered for drugs under Pharmacare and the resident wouldn't. You can't compare those kinds of additional health care programs unless you're suggesting that provinces across Canada not only standardize medicare -- which I believe we should -- but also pharmacare, the travel assistance programs, whether they cover certain medical devices and the whole lot. That would perhaps be a desirable goal, but we're very far from it in this country. Certainly those provinces which have far fewer resources to spend on health care would be hard-pressed to fund a pharmacare program or fund some of the other programs.

[7:00]

What the member is suggesting when she talks about providing dollars to the travellers' clinic is that we fund excess capacity. In a perfect world I would love to be able to do that, but in times of a shortage of dollars I think there are other things that we really need to put our money into. She is suggesting that we fund private capacity over public capacity. Again, if there is additional money that can be found to be put into kidney dialysis, my preference, and the preference of this government, is that we spend that money in public facilities, and that we do not support the establishment of private health care clinics.

L. Reid: The continued reference to the Alberta-Prince George scenario is only an example. Both of us could cite many examples of different situations across this province. That's not resolving or clarifying the issue. You made the point about excess capacity in private or public facilities. The point, and the issue, for today is whether or not.... If I need dialysis, and I am not able to secure it at, for example, St. Paul's Hospital, and it's going to cost the province of British Columbia $290 no matter where that $290 is spent, it's a fixed cost for the province. I still need the dialysis, so for me to walk across the street and get it at the kidney dialysis clinic for exactly the same price.... Why is that an issue? I'm not clear where you're headed with this discussion, because quite honestly, I'm going to need it three times a week for four hours a day, regardless of whether I'm in St. Paul's or at the clinic in Prince George. I mean, if you're not able to provide that service in the hospital, my life is threatened. Can we look at some other options here, some other alternatives?

Hon. E. Cull: No one's life is threatened. Where people need services in their community, they are provided. What we are unable to provide -- and I acknowledge this -- is the ability for people in this province to travel wherever they like and have there be excess capacity in the system for kidney dialysis. It's unfortunate. I accept the fact that it is a restriction on their lifestyle. Other people have disabilities and illnesses that place similar restrictions on their ability to travel. If the member is suggesting that we should provide excess capacity in the system as a priority over other issues which I think are more important, and that we should do that rather than putting our dollars into public facilities, should we have that additional money -- we should put it into private facilities -- then we have a basic, fundamental difference in how we think health care should be provided in this province.

L. Reid: Again, the issue is not in an ideal world where hopefully all of us could travel anywhere we like. For a lot of folks who require kidney dialysis, it's travelling anywhere at all. That's the question. We have not resolved that question today. No, we are not tackling the public versus the private aspect of funding health care. This is the cost of the patient. Should you reimburse me for my cost -- $290 -- regardless of where I receive the service? That is the question to you. My view -- and I would submit that to you very strongly today -- is yes, you should. It's not funding the private system; it is ensuring that I receive dialysis without staying in my home community, tied to the service, say, in Prince George, without being able to leave that community for more than a day and a half at a time. That is the concern for British Columbians, and that's the concern for the people who contact my office.

This is about choices; this is about having some health care options. What you're saying is: "Well, it's really unfortunate that we can't provide those services in all parts of the province. That's too bad, but we don't have an ideal world." That does not respond to the fundamental issue that they have brought forward today, which is if it's going to cost exactly the same amount, and the government's going to pay it, let's pay it so they have some choices. That's their concern.

I was looking for a response to the question. However, seeing none and seeing the government House Leader, are we indeed adjourning at 7 p.m. and moving to Bill 51?

Interjection.

L. Reid: No problem.

I'm going to be asking some questions in terms of labour relations in the health care field. We certainly are of a view that the health care sector has not been running smoothly over the last number of months, and we certainly support the notion that health labour relations are not your mandate exclusively. However, we strongly believe that the Minister of Health has a responsibility for labour relations within institutional settings, within community settings. Having made the point that it is, indeed, a shared responsibility between the Minister of Health and the Minister of Labour, I'd like to get an idea from the minister about her views on labour relations in health care and how disruptions of service can be kept to a minimum in the event that problems arise.

Hon. E. Cull: I think the best way to keep labour disruptions to a minimum is for both the employer and the union to work together, to negotiate collective agreements and to put in place contractual provisions

[ Page 3244 ]

that will allow for a positive working environment in the institutions in this province.

L. Reid: It's our view that during the HEU strike the quality of health care in the province was seriously compromised. Does the minister believe that essential services in the health care sector were maintained at an appropriate level? Has she recommended to her colleagues that they be changed in the event of further job action in the health care sector?

Hon. E. Cull: There's a process in place under labour law that allows essential services to be established. They're negotiated between the employer and the union. No fixed level is established. Furthermore, the employer -- as they did in this case -- can go back to the industrial relations people and ask for an increase. That did happen. The Royal Commission on Health Care and Costs, as I'm sure the member is aware, has recommended that essential services be established outside of the periods of dispute. It sounds like a fairly sensible recommendation to me and it's one that we're reviewing.

L. Reid: In our view, the HEU strike dragged on for far too long, and health care for British Columbians reached dangerously low levels. At the time, we suggested arbitration early in the dispute. Can the minister tell us how she feels about changing the system so that parties are forced to enter into the arbitration process at a predetermined time after job action has begun?

Hon. E. Cull: It's a question much better put to the Minister of Labour. As the member knows, we're doing a review of labour legislation, and I imagine such things will be addressed in that.

With respect to the length of the dispute, as the member knows, I was in contact daily with the major hospitals. They advised me at which point they felt things were starting to get serious with respect to patient care. When I received that notice, I spoke to the Minister of Labour about moving the process along, and it was.

L. Reid: Your most recent comment was that during any labour disruption, and certainly during the previous one, you were in contact with the major hospitals daily. I need to hear this evening how you intend to stay in contact with all the community care providers in the event of labour disruption, because I believe they will be unduly affected by that. How do you intend to ensure that adequate levels of care are delivered?

The Chair: With all due respect, hon. member, that's a very hypothetical question. If in fact a labour dispute were ever to happen in the community health care system some time in the future At any rate, it's very hypothetical.

L. Reid: I appreciate your comments. However, I would submit to you this evening that the health care workers that we will have delivering health care in our communities will be members of the existing union structure -- HEU workers, as an example. Indeed, the minister will have responsibility for health care. Again, how will she stay in touch so that she knows that essential levels of service are being provided?

The Chair: Before I recognize the hon. minister, I would suggest again that it's a hypothetical situation, and I caution the minister to guard her answer.

Hon. E. Cull: The member is aware of the Korbin commission, which I have asked to look at the structure of the employer side of the health care issue. I expect that commission to be providing me with advice that will give guidance to her questions.

L. Reid: We noted with interest that the government committed extra dollars to health care to contribute to the added costs of implementing pay equity in the HEU contract. Can the minister give us the details, and whether she feels this will be enough to achieve the pay equity that her government promised? And are there any graduated stages that we should be made aware of?

Hon. E. Cull: Additional funding was provided for pay equity. I don't have those figures in my head, but the hospital budgets have been adjusted accordingly to deal with the pay equity settlement. The whole question of whether it's enough is something that the employer and the unions are determining.

L. Reid: As the minister is aware, women make up the majority of workers in the health care field. What about child care for these health care workers? Is the minister taking steps to introduce widespread availability of such services for health workers?

Hon. E. Cull: I'm sorry, Mr. Chair, I was trying to get the information for the last question and didn't hear the question. I heard the preamble but not the question.

L. Reid: My question pertained to child care services and what involvement you would have to ensure that child care services were available to workers in the health care field.

Hon. E. Cull: Within the capital budgeting, we do have a look at the provision of child care facilities in all the buildings that we're building. I have asked my staff to pay attention to that need in their communities when they are doing capital planning, but that is the extent of it. It really is a matter between the employer and the union in this case providing health care to the employees of the hospitals.

I have been advised that it's time we have a dinner break and move on to some other business, so I move that the committee rise, report progress and ask leave to sit again.

The House resumed; the Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

[ Page 3245 ]

Hon. G. Clark: I call second reading of Bill 51, hon. Speaker.

BRITISH COLUMBIA
TRANSIT AMENDMENT ACT, 1992

Hon. G. Clark: I move the bill be now read a second time.

Bill 51 amends the British Columbia Transit Act to provide the Vancouver Regional Transit Commission with three new options to deal with the $28.8 million local revenue shortfall projected for the 1992-93 fiscal year. The primary reason for this deficit is, of course, the rather expensive capital costs of SkyTrain and the completion of the SkyTrain extension to Whalley. That was one of those unfortunate situations where.... I won't criticize the previous administration except to say that these bills have a way of coming home some years later. Of course some of the financing of SkyTrain was easy to enter into by any government, because the bills aren't paid for some years hence.

[7:15]

Each year the commission is required to pass a funding regulation, which sets out how it will raise its share of operating and capital costs of transit services in the region. The regulation must then be approved by the Lieutenant-Governor-in-Council. Based on its existing revenue sources, which include fares, a regional transit gasoline tax, a non-residential property tax and a levy on residential electricity bills, the Vancouver Regional Transit Commission was unable to fund transit services in '92-93 at the levels it wished without raising fares and taxes -- again because of this looming deficit. The province, however, refused to approve such increases, since it would be regressive and could exacerbate the cross-border shopping problem in the lower mainland. Essentially, they asked to significantly raise bus fares, and they asked to raise the gasoline tax. I think anybody in British Columbia, but particularly in the lower mainland, would realize that the cross-border shopping problem would really be exacerbated by another 1 or 2 cent tax on a litre of gasoline -- even though, in some respects, I'm sympathetic to the environmental notion of taxing carbon fuels. Clearly, there is a problem in the lower mainland. That problem may not exist, I say hesitantly, in the Victoria region, which has also requested a gas tax, which we have turned down at the moment. I'm more receptive to the notion in southern Vancouver Island, because we don't have those pressures of cross-border shopping. There is a nice environmental link between taxing gasoline and paying for public transit.

Through the Budget Measures Implementation Act, 1992, which was recently passed by the House, the province moved to extend the existing '91-92 funding scheme into a new fiscal year to allow time for discussion on improved cost-sharing arrangements to take place with the commission. The commission, however, has declined to begin such discussions unless it is provided with some means of dealing with the funding shortfall of '92-93, which results from extending the old funding regulation.

Just to recap, we allowed the commission to continue operating under the old rules for some time while we negotiated it. They refused to meet and said: "It's too big a deficit, and we want some action." I did have some extensive consultation with members of the commission. There were a couple of changes, but not overwhelming changes to the makeup of the commission. We've decided to bring in this bill to at least begin the dialogue with the Transit Commission on how to deal with funding questions.

The amendments to the B.C. Transit Act contained in this bill provide the means to begin to address this projected local deficit. The first allows the Vancouver Regional Transit Commission to raise less than its portion of funding required under the current cost-sharing formula for '92-93, on the condition that the shortfall which this would create is carried over into next year and offset completely by revenues in '93-94.

In other words, in some respects there's a bit of tension between fixing this problem, which obviously the government and the Minister of Finance could probably do, and entering into a meaningful process of dialogue with the local communities -- to not fix this problem by action on the part of the provincial government but to work with the local communities and fix the problem. Contrary to some people's remarks about my own behaviour, we decided not to take action unilaterally and fix this problem, which we clearly have the power to do, but rather to enter into a meaningful dialogue with the local communities in the lower mainland on how to really deal with this governance question. In my view, we need to devolve more authority to the region, or the converse, which is simply to take it over provincially. This current hybrid is really not working. My preference, clearly, is to devolve authority to the region and give the region more control over transit in the lower mainland.

In order to pursue that more substantial change, which is a governance model, and fundamentally look at how we govern transit in this province in keeping with the way it is really in the rest of North America -- particularly Canada -- then one of the by-products was not being able to fix this deficit very easily. We want to make sure that the local communities are a part of this solution. That's why we had to -- much to my concern, frankly -- allow a deficit carryover for one year only, rather than have the province take action to work with local communities.

That's the first change. It allows the regional transit commission to raise less than its portion of funding required on the current cost-sharing formula for 1992-93, on the condition that the shortfall this would create would be carried over to next year and be offset completely by revenues in 1993-94.

The second change we make in this bill gives the commission -- or any municipality or transit commission in the province, including southern Vancouver Island -- wishing to fund additional transit services the ability to levy a tax on land and improvements used for vehicle parking other than for residential use. So residential parking is not an option here, although I want you to remember that the existing act allows municipalities and the transit commission to levy a

[ Page 3246 ]

property tax. residential or otherwise. Obviously that is not being contemplated at this time, but it is already in the act. This excludes residential parking from it but allows commercial parking to be taxed. The geographic areas to which such a tax would apply and the rates to be charged would be set by local authorities, again subject to approval by the Lieutenant-Governor-in-Council -- in other words, the current mechanism.

Finally, the third proposed change would allow the current transit tax on non-residential property to be extended to land which has no improvements on it, which I believe has other beneficial impacts -- to spur development, for example. It's a very modest tax which would simply be applied to vacant non-residential land held largely by developers. The new options proposed in the bill and meaningful discussions between the province and the commission can now commence, because we have a couple of other options available. These talks will address not only this year's short-term funding problem but also changes to the overall governance and funding structure for transit services in the greater Vancouver region.

The first point I want to make about parking-lot taxes is that we are not imposing a parking-lot tax. We are giving that option to the Transit Commission. There are very good environmental reasons for linking this tax -- equally good, in my view, to the gasoline tax. The gasoline tax is environmentally positive in terms of linking it to public transit, but it has the problem -- increasingly in the lower mainland -- of cross-border shopping. This is another mechanism which is very environmentally sound. It's taxing people who park their cars for commercial purposes and using that money directly for public transit. It is a very good linkage and one which can really help move along public transit and governance of public transit.

I want members to know this is not pioneering legislation. Toronto has exactly the same kind of tax. I'm advised that if it were applied at the same rate as Toronto, we wouldn't have this deficit. We would probably have more money to improve public transit and to review it. I want to make the point that this is only a partial solution. We want to make sure that there is a governance question to fix this problem, to give more authority to the region and to the municipalities in governing transit.

At the same time, with that authority comes responsibility for raising a certain amount of the revenue. The British Columbia government will always be a major funder of transit in British Columbia. The sum of $200 million or so in public funding for transit is the highest in Canada from a provincial government. As a member from the lower mainland, I say to those of you from outside the lower mainland that you should be aware it is your provincial tax dollars that are subsidizing the lower mainland transit system. That subsidy will continue, but it cannot continue at its present dramatically escalating rates over time, particularly when we clearly need transit to Richmond; we clearly need and support public transport to the Coquitlams and to that northeast corner of the lower mainland. There is no question but that we have to proceed on those major infrastructure investments. The bottom line is not the only thing to be considered, but in order to make this system work we need to make sure the local communities are consulted. We need to make sure that the regions of British Columbia in the lower mainland are a party to those decisions. It's not acceptable, in my view, for the province to be imposing a system against the will of local municipalities. We want to work with those local municipalities on funding this very serious problem.

This is good environmental legislation, and I ask all members to support it. Remember that it is only enabling legislation, and in some respects the goal is not to fix this short-term problem with a tax on parking; the goal is to fundamentally change the governance structure to give the local communities more say and authority in transit and more responsibility for transit funding. The province will continue a major subsidy for public transit in the lower mainland, but we want to ensure that major capital improvements and other transit improvements, which we believe in on this side of the House, will be funded in a reasonable way, working with local communities.

One last point just to advise the House that everybody in British Columbia, outside the lower mainland and southern Vancouver Island, pays for transit in their communities. Kamloops, Prince George and Penticton -- all those towns -- pay on the property tax base for their transit services. It's only the lower mainland and southern Vancouver Island that do not. This moves a small way in that direction by making sure that there is some payment -- in this respect a property tax -- for transit. It's good environmental policy.

This is a beginning of a dialogue with local communities to build upon, a positive step environmentally and also, I believe, a positive linkage between users of private automobiles and funding for public transit. This is a beginning; it's not the end. I hope that we will work over the next year to get a funding formula that works and that is supported by the local communities and, more importantly, a formula which allows us to move ahead dramatically and quickly, in my view, on major transportation links, particularly to the Coquitlams -- to that corner of the province -- and to Richmond, areas which desperately need significant improvements in their transit systems, which this side of the House is supportive of.

F. Gingell: The government of British Columbia has some important decisions to make. Certainly we appreciate that the first one is to determine whose responsibility transit is. Is it provincial, regional, or municipal? In this particular case, we are dealing with a transit system which has been built at a cost of close to $1 billion.

Interjection.

F. Gingell: That's $1.2 billion -- I'll go along with that -- and growing.

Operating revenues -- fares -- are raising a little less than 50 percent of the current operating costs. That's the operating costs only, and it does not include the capital costs or the debt service costs.

[ Page 3247 ]

Under normal circumstances, if this system had been installed by the Greater Vancouver Regional District, as their decision, we would all look for there to be some form of a user-fee cost recovery. In the end, we have to find some means by which the ridership of this system will cover its cost. It really doesn't make logical sense for transit to be subsidized by automobile drivers. Certainly we want to find the ways and means of encouraging people to get out of their cars and onto the transit system. But that should be done by speed and convenience -- those kinds of encouragements. It seems to me difficult to suggest that it is reasonable to simply tax the use of cars and the use of parking-lots.

I understand that there are roughly 52,000 commercial parking spaces, not including residential ones, in greater Vancouver. For them to cover this anticipated deficit of some $29 million, they will have to levy a tax of roughly $550 for each parking space. Hon. Speaker, why should such a....

Interjection.

F. Gingell: Fifty-two thousand was the number I was told by the DVA, the downtown Vancouver people. If this tax were just levied on the downtown area, then you are giving a subsidy or creating an incentive for the malls and the stores in suburbia. That obviously isn't logical or fair.

[7:30]

Rapid transit, the thing that we all support, is what it says -- rapid. Other forms of public transit tend to be not so rapid. If I, who live in Tsawwassen, wanted to go by bus to the offices where I worked for many years in central Burnaby, it's a difficult exercise and takes something like an hour and three-quarters. One can imagine adding onto a regular eight-hour day almost four hours waiting for buses and changing buses. It doesn't seem logical that we should have a tax that would clearly tax someone because they were at a disadvantage because they happen to live in an area not served by rapid transit.

How do we deal with those kinds of problems? Certainly from an environmental point of view and from the point of view of the use and the building up of the traffic on our road systems, we need to encourage car-pooling. It makes a lot of sense and is something that I believe the government encourages. But for those people who really don't have the transit option, to cause them to pay substantially increased rates to park their car because they have to go to work to earn enough money to pay the mortgage and feed their families, really doesn't seem like a logical way of proceeding.

We have to ensure that we find a way of covering the $29 million or $30 million shortfall by some fair and equitable means. Now if we were to raise fares by roughly 20 percent -- and I understand there hasn't been a raise since 1990 -- we would cover the amount of the shortfall. That would be my first choice. I do not believe that a 20 percent increase in fares would, of itself, cause a decrease in ridership. It certainly seems to be a much fairer means than taxing people who happen to drive automobiles, because in the end, of course, these costs are going to be passed on.

It's going to have all kinds of other effects, too. I don't know if you have recently been out to the PNE or the Coliseum, but the lineups for the parking-lot there are exceptionally long. All you have to do is drive down the streets around there, and the small children run out with signs offering you places to park your car. There's going to be much more pressure on people looking for illegal parking spaces where they don't think they will be caught, and there's going to be a lot more pressure on Vancouver street parking spaces.

During the course of the minister's opening remarks on this bill, he spoke briefly of the situation in Toronto, where a CCT -- commercial concentration tax -- has been levied.

Interjection.

F. Gingell: No, it isn't, not yet.

But it is in a form, because at the moment there is the ability to tax non-residential property. You are now adding the ability to tax vacant land. You would tax non-residential property, and you would tax vacant land. Haven't you got the same thing as the CCT? Almost? Close enough?

Certainly businesses in downtown Toronto have been very negative to this tax. There are all kinds of problems with it. There are suggestions -- I don't know how badly they have been exaggerated, because I haven't been in Toronto for quite a while -- that it is forcing commercial businesses to move out of the downtown area into the suburbs, and that there's a much higher vacancy rate of stores on the main downtown streets, places being boarded up and that kind of thing. That's certainly not something that we wish to....

Interjection.

F. Gingell: I don't know why you keep pouring all the problems of Liberal administrations around the rest of the country on our shoulders.

An Hon. Member: A Liberal is a Liberal is a Liberal.

F. Gingell: I wouldn't be too sure of that.

Hon. Speaker, the problem has to be solved. I would have much preferred to have seen the minister sit down with the members of the B.C. Transit Commission and with the senior politicians of both the Greater Vancouver Regional District and the Capital Regional District to find some solutions first before bringing in this bill. I understand that this bill does not bring into effect any of these taxes that have been discussed, but it does bring in the ability to raise these taxes.

It is a nice, simple way for the government to bring in this bill at a time when the House is sitting, obviously while the spotlight is on us all, and for them to say: "People of British Columbia, we have not brought in a tax; we have just got ready for finding solutions for the unfunded costs of the B.C. Transit System." Then when the House has adjourned and the spotlight is off and there aren't all the members.... They're not there now

[ Page 3248 ]

anyway, all the members of the press gallery watching with their eagle eyes and reporting very little of what actually happens. Then when everything's quiet, putting this tax through at a later date. It's an unfortunate way of doing things. I personally would strongly prefer an increase of fares of 20 percent. That would look after the problem. That's the way I feel. There have to be solutions.

J. Weisgerber: It's a pleasure to rise and speak to this piece of legislation, Bill 51. As I listened to the minister introduce the bill, he stressed to us that this was in fact enabling legislation, that this wasn't the province imposing a tax on British Columbians or on those located in any particular region of the province. This was an enabling piece of legislation that would allow municipal or regional governments to implement a tax to pay for transit. He then went on in some considerable detail to tell us about the deficit in the greater Vancouver region and the need for that area to raise $28 million or so to overcome their deficit. It was pretty clearly linked, and I don't think anyone has tried to hide that at all. This bill is being brought in so the Vancouver Regional Transit Commission can apply a tax on parking spots and on vacant land to cover the deficit.

I want to start by recognizing that funding public transit is a difficult issue. There is the option, as the Finance critic for the Liberal Party indicated, of increasing the fares. On examination, the result of that is to drive down the ridership and at the end of the day make the deficit even larger. So while at first glance that might look like an option, I think most experts in the industry with some examination would reject that as being somewhat counterproductive. I think, though, that there are also a number of other options that local government and the provincial government have. You could tax all of the property-owners served by the system. That would provide one way of funding it. You could tax everyone in the province. As the minister has indicated already, British Columbians are being taxed across the province whether they use the system or not. Or you could tax the land that people who don't use the system park their cars on. Somehow the minister suggests that by doing that, you encourage more people to ride the system. He interprets that as being environmentally friendly. It's a bit of a leap of faith, I'm afraid. I think we've made quite a jump from taxing commercial parking spaces to somehow helping the environment. But we'll go along with that and see how it goes.

He also says that he doesn't want to encourage cross-border shopping. That one I really question. I mean, let's face it, you can park your car at Bellis Fair. You know you're not going to be taxed down there for the Vancouver transit commission; whereas I understand from this bill that non-residential parking spaces -- whether they be at malls or whether there be a charge for parking, or otherwise -- would most likely be taxed. The question is: do you also charge parking-lots where people park their cars to use the park-and-ride aspect of public transit? No, you don't tax those spots. So you're not going to tax all of the non-residential parking spots.

Interjection.

J. Weisgerber: You don't tax those.

It seemed to me, anyway, as I looked at those options.... Would you tax the broad tax base? Would you use the approach of specifically attacking property? Would you use vacant land? Why would you choose all of those things?

One of the approaches recommended in 1989, when we were in this House debating the estimates of the minister then responsible for transit....

Hon. G. Clark: Who was that?

J. Weisgerber: That was Rita Johnston, the minister.

Hon. G. Clark: I remember her well.

J. Weisgerber: Another person you'll remember well rose in this House to engage in the debate. They were talking about how you would fund transit and what the fair approaches to funding were. You will recognize this individual: the then Leader of the Opposition, the gentleman who today is Premier of British Columbia. His solution, and I quote from Hansard.... Actually, for anyone who would like to look up Hansard, it's May 4, 1989, and the page is 6592. He said: "I think the minister would agree that if we're going to have the LRT extensions we need, the capital cost of the LRT has got to be treated in the same equitable way that a freeway is, and 100 percent capital financing for the LRT...has to come from the province." That was the position taken by the then Leader of the Opposition, today the Premier of the province.

[7:45]

If the Premier believes that transit should be financed across the province on the general tax base, why hasn't that happened? You would think that if he really believed in that in 1989.... While he couldn't implement that position in 1989, today he is in the position of having the authority. I would assume that he could have influenced his cabinet to support the kinds of arguments that he made on May 4. You wonder why that would not happen.

Why would the government go in the opposite direction to that argued by its leader? I would suggest to the members of the House that the answer is found on the next page of Hansard, page 6593. On that same day, in those same debates and almost immediately following the comments by the then Leader of the Opposition, one Bob Williams rose in the House. He had quite a different approach. He didn't agree with his leader on how you should deal with this question of finance. He suggested: "It does seem to me that it would be reasonable to give the municipality the option...." When we hark back to what the minister has just said, those words seem to echo a bit. He then goes on, over the next couple of pages of Hansard, to suggest that the appropriate way to deal with this would be to tax vacant land. Land was the villain. You should go after vacant land and tax it, because that will

[ Page 3249 ]

drive the owner of the property to make more productive use of it.

An Hon. Member: Well, then, who's boss?

J. Weisgerber: I think it has been demonstrated time and time again. The member asks who's boss. I think we all know who the boss is. I think that this legislation only confirms the suspicions that we've all had that the individual who calls the shots for this government is the same fellow who rose in the House on May 4, 1989, and argued against the Leader of the Opposition -- the Premier today. In fact, he argued in favour of almost exactly what we see today in Bill 51: enabling legislation, something that gives the municipalities the option, a focus on vacant land and a focus....

An Hon. Member: Where are you on this?

J. Weisgerber: Where am I on this one, the member says. Where I am is that I think you're not going to achieve what you want to achieve as far as the issues that surround transit in this bill go. You're going to make Mr. Williams happy, because he will again see one of his pet projects, one that he's been quoted on not only in Hansard but also in Equity in December 1989.... Mr. Williams is quoted as saying: "I think there's a need for a fundamental shift in property taxation from land and buildings to land alone." Indeed, Mr. Williams appears to have had a major hand in writing this piece of legislation. The members want to know which of the two I agree with. Do I agree with the official Premier, or do I agree with the de facto Premier of the province? I don't think it is particularly important for me to decide. Perhaps it's more important for the NDP caucus to decide -- and it appears they have. Perhaps it's more important for British Columbians to understand what drives this government and the decisions that this government makes. It appears to be leadership -- not leadership by the Premier but leadership by Bob Williams. It wasn't long ago, during the Minister of Finance's estimates, that Mr. Williams sat in the House and the minister said: "He's a pretty benign character; he really doesn't have much influence on the government. He does a few little chores for us with the Crown corporations, but everyone exaggerates his influence on the government. It really isn't very significant." So what we have is a piece of Bob Williams legislation here today.

I would suggest that there are better ways to tax for transit than to identify commercial parking places. I think in many ways it taxes people who don't have an option. SkyTrain is the one that drives the deficit; we know that. Certainly if people have an option to use SkyTrain and are taxed if they don't, that's one approach. But you're going to tax everyone in the area whether they have a real option to use SkyTrain or not.

We're not very happy with that approach. I think that it would be far more equitable to tax everyone who is served by the system. If I were to encourage an option.... Of course, that's really not our responsibility, but it is our responsibility to look at legislation and decide where it falls short. I don't think it meets the test as far as cross-border shopping goes. Quite the opposite; I think it would in some ways increase costs for businesses and therefore make them even less competitive. It targets a small group of people in a way that's inappropriate for taxation on this particular service.

So despite the minister's encouragement for all of us to stand up and support the legislation, we won't be supporting this particular bill.

A. Cowie: Clearly, we have to have transit planning with land use planning. I believe part of the problem with this is that the people responsible for transit planning over the last number of years -- the Social Credit government -- had a complete lack of planning. It's largely their fault that we're in this mess. It's clearly the NDP government who now has to pick it up. It's like the deficit situation. That's part of the problem with this new measure that's being brought in. It's not being done properly as planners would want it to happen. It has been done by an anti-planning government, and now this NDP government has to try and take on the responsibilities for it.

Surely they would have been more imaginative and looked longer out there -- took a five-year approach. As the hon. Minister of Finance has said, you have to look at Richmond, you have to look at Port Moody, and then you have to look at Coquitlam. You'll even have to look at Port Coquitlam someday. As you get these transit lines planned, surely this government would have been more imaginative than the previous government. I would have thought that they would have looked at bonusing developers at transit stops and then charging them sufficient fees so that they could pay for these deficit situations. As the price of land goes up around the transit stops, the government would benefit from that and, again, put it back into capital works on the transit system. I would have liked to have seen the minister, maybe working very closely with the Minister of Municipal Affairs, show some imagination. I haven't seen that, and therefore I'm very disappointed.

I have some sympathy, however, with this government bringing in this charge, because they've taken a very academic approach. Just imagine, for example, a large parking-lot down on Georgia Street. At the present time there's police going by; there's sewer going by; there's water going by; there's a lot of municipal costs. When you see this vacant lot, you say: "Shouldn't the developer, who's just waiting for the right time, be charged a cost for having that vacant land there?" I can see that; that's a very academic approach. But on a practical point of view, I ask you to look at some of those parking-lots along Georgia Street. They're only a third occupied. They not only charge between $7 and $10 a day, plus GST.... The owners have to pay more, now that the government has brought in the corporate capital tax. Eventually it gets so that the charge on that lot is too much and people don't use it. What they do is what my hon. friend sitting next to me says: they go to the surrounding streets in the neighbourhood of the west end, or they try to park down into Stanley Park, try to get some free parking there. Then I find.... This is the most ludicrous situation. You have tourists, you

[ Page 3250 ]

have families trying to visit the zoo, and there are parking-lots down there. Now those people are going to have to be charged an additional fee to go see the animals or to go see the aquarium. They can thank this government and the Minister of Finance for that. Every time they put their quarters in, they can say, "That's the Minister of Finance adding an even greater burden." He has not attacked this in a very imaginative way. What should have been done is to put this on a much broader base.

If you don't like my comparison to the lot on Georgia Street, I then would like to take you to one of the suburban lots. Let's take again my hon. friend next to me, and let's go to Tsawwassen. There you have a parking-lot around a shopping centre. Do you think the owner of that shopping centre is going to put in parking metres or charge people to park there? Certainly not. What the owner is going to do is add the price to the bread, the milk and everything that's bought in that shopping centre. Already the stores are having a hard time, and some of them are going under. That's just going to force more and more cross-border shopping. So that's not going to help.

The minister, to be fair, is going to have to encourage the municipalities to tax those vacant lots the same as they tax the vacant lots downtown. That's fairness. You cannot have one charged and one not charged.

[8:00]

What the NDP government should have done is stayed with the original formula they had. They shouldn't have just taken a short-term view. They should have stayed with the agreement they had with the transit commission. Of course, members of the transit commission didn't agree with the present government; therefore the minister fired them, changed the members just like he's done with the transit board, the overall authority. Instead of having 13 members, now we've got 19 members. That makes it all the more difficult. More members of his faith, so he can tell them exactly what to do. Not to have the mayor of Vancouver is absolutely atrocious -- the mayor of the largest city with the largest responsibility. I would have thought that the minister would have been trying to seek cooperation from that mayor, and he's certainly not doing that.

I don't like to stand up here and criticize without having a solution. So I have a solution that's fair, and I would ask the minister to look at it. If he has to charge to get this $29 million, I would ask that a levy be put on those cars that you see every day heading into Vancouver with one person in them, going down to a corporate office and parking; they should be encouraged to have two or three people in them in order to pay for that parking. Those are the people who should be charged. It should not be the commercial users, which adds to the price of everything we buy, whether it's downtown or in the outside commercial areas. Let's get serious, and let's tax the people who should be taxed in this situation.

D. Symons: I too rise with concerns about Bill 51, because I see this as another downloading of responsibility from the provincial government onto the municipalities. They say they're not doing this, and that all they're doing is opening the ability for the city to do it. But basically they're not leaving many other options.

It is another one of the non-delivered promises of this government that said: "No new taxes." This will be quite a new tax if it is imposed by the city of Vancouver or the Greater Vancouver Regional District, which it's aimed at. It certainly is going to be a new tax. It may not be this government that puts the tax in place, but it's going to give them the ability to do it and pretty well give them no other option but to do it. In that sense, it is indeed a new tax imposed by this government indirectly.

H. Lali: Move north.

D. Symons: The hon. member says: "Move north." I'm afraid we'll find that a great number of people are going to shop south because of this particular bill. It's going to increase the costs of doing business in Vancouver, and that will pass on to the price to the consumer and encourage the consumer to go somewhere else, possibly south of the border. The government will be contributing to cross-border shopping once again with the ill-advised tactics and taxes they're putting on the province of British Columbia.

We find that what has really happened is that the government has reneged upon a promise by the previous administration to put enough money in to cover the capital cost of approximately $30 million in the B.C. Transit decision.

Interjection.

D. Symons: No, the reneging was not the previous government's fault; the reneging falls upon the administration that's currently in there. This is the government that does not seem to be able to keep promises of government. It really doesn't matter which government made the promise; it matters which government has the backbone to keep the promise. We do not have a government that seems to be able to do that. They simply renege on promises, whether they are to the doctors or to the Greater Vancouver Regional District for transit. By refusing to honour the funding obligations, this government is simply passing the buck on to the municipalities.

This bill is unfair to the businesses in the Greater Vancouver Regional District. It's going to increase the parking fees or the prices. If a store or business does not charge a parking fee, it will simply pass it along to the consumers in increased prices. This is going to drive the shoppers and the businesses elsewhere, and a lot of that may be south of the border or outside the Greater Vancouver Regional District. It will help other districts further out the valley, but it won't help the situation in greater Vancouver. Businesses that provide customers and employees with parking spaces will now be taxed for providing this courtesy. That is not an incentive to a company.

It seems to me that not many years ago.... I believe it's still the case in Vancouver and in Richmond that when a new business is put in, they require that

[ Page 3251 ]

business to put in a certain number of parking stalls. There's a requirement, depending upon the type of business, that parking stalls be included. So then we have that problem: we're insisting you put in parking stalls, but we're going to tax you when you do it. This is a real problem. I think it's unfair to do that to businesses. On the one hand we say you must do it; on the other, we're going to tax you when you do it. It's going to drive businesses out.

I also find that there are other places that are going to be taxed as well. That's going to be passed back to the taxpayer in an indirect way. I assume that the parking places in school grounds and at municipal buildings are also going to be taxed, and the parking places at provincial government business places. If somebody goes in and finds a parking space where the offices are for, let's say, the motor vehicle branch, and there are parking stalls in front so people can come in to get their driver's licence, these parking stalls will be taxed. Who is going to pay the tax?

H. Lali: The taxpayer.

D. Symons: It will indeed be the taxpayer -- correct.

We're managing to add in a new level of taxation here. My belief on this is -- and it was mentioned previously by the hon. minister, and I'll just get back to it in a moment -- that transit should be funded in the same manner as the highways of this province are funded. That way, it comes from general revenue. With the highways, we are providing a highway to move people between areas. And what does transit do within the city? The same thing. So transit is simply a basic highway within a city where there's enough population to warrant that type of highway. If you didn't have transit there, you would need more roads, highways, within the area, so transit is simply an alternative to it, and it should be funded that way.

Earlier the minister said that what's happening is that tax dollars from the province are subsidizing what's going on in the city of Vancouver in the way of public transit. I say that is true, but the reverse is also true: the taxes in Vancouver and the Greater Vancouver Regional District are going to pay for highways throughout the province. So it works both ways.

Interjections.

D. Symons: You don't believe that a lot of the tax revenue in the province of British Columbia is gathered in the Greater Vancouver Regional District?

Interjections.

D. Symons: Is that not true?

The Speaker: Order, please, hon. members.

D. Symons: And those taxes go to pay for highways throughout the province. It's a fact. You might shout all you like that you don't want it, but it cuts both ways. The minister over there is not willing to accept that, but that's the fact.

He also mentioned that we have the gas tax versus what I will call the Clark...

Interjection.

D. Symons: Well, it doesn't work too well if I say the other, but I better not say this. I'm not supposed to name a minister, and I wanted to put a name to this tax, but I think maybe I'd better not. Anyway, a parking space tax. Well, he said if we put the gasoline tax on, it's going to drive people south of the border. Won't putting a parking stall tax on do the same thing? I certainly suggest that it will have the same effect.

I have here a letter, and I would eventually like a response from the minister because it's a letter addressed to the minister from a group of people in Vancouver -- businesses. It comes under the letterhead of the Canadian Federation of Independent Business, but it names at the bottom some other groups in Vancouver: the Real Estate Board of Greater Vancouver, Tourism Vancouver, Downtown Parking Corp., Vancouver Urban Development Institute -- quite a few organizations here. It says that these people have some serious concerns. They say:

"...without a proper consultative process to obtain a clear understanding of the consequences on the business community and consumers in this region. They have joined in this communication to you.

"We respectfully request that you delay introduction of this bill so that a consultation process can be introduced. To this end, the following organizations... have formed a task force to seek alternatives, and we will be pleased to work closely with your ministry on this and other options."

Has that consultation taken place? Have you responded to this request in some way so that meaningful consultation on this particular piece of legislation has taken place? You will have your opportunity later to respond to that.

My final question is: how much is this going to cost? They are trying to amortize a capital cost of approximately $29 million. They have devised this way of avoiding provincial responsibility for what was basically a provincial decision. It was not the city of Vancouver -- and I think the Premier, who was mayor of Vancouver at that time, will vouch for this -- that decided on the technology that went into rapid transit in Vancouver. It was foisted upon them by the previous administration. We know where the blame lies on that one. It was expensive technology that the then mayor of Vancouver rejected but had put upon him.

Now that this has been foisted on Vancouver, we're going to get the double foist. We're finding that the expense, which the previous administration at least admitted to and was going to pay, is going to be foisted on Vancouver and on the Greater Vancouver Regional District as well. They're paying twice for the mistake of the previous administration, and you are making the second payment due.

What I'm curious about -- the minister might answer this later on, because they know that they're trying to pay back $29 million -- is how much this is going to

[ Page 3252 ]

work out to per parking stall per year for the number of stalls in Vancouver to amortize the debt, and over what period. I'm sure that the government must have worked this out in order to come up with the scheme to do it. I would like to hear the minister tell the people in the Greater Vancouver Regional District how much he's expecting them to pay. The city hasn't really been given any other option but to go by this legislation, because they've taken away the other options. They've put in a transit board that's going to be subservient to the government, with no mind of its own. We have this problem. How much is it going to cost? I leave those questions, and I hope that they'll be answered later on during this discussion.

M. Farnworth: It's a pleasure to rise and speak to Bill 51, to address some of the elements contained in the bill and some of the questions and comments from my Liberal colleagues on the other side of the House. I can tell the third party that I will not be making as many references to them as the previous speakers did.

This bill is part of a process of devolving power down to a regional authority. I find really interesting the comments from the member for Richmond Centre that this bill is downloading. It's not downloading; it's a decentralization -- putting the decision-making for transit and transit financing at the local level, where it should be. The member for Richmond Centre talked about funding transit out of general revenue, which obviously means they intend to run it from the provincial level. Why else would the province totally fund the cost of transit, if they didn't intend to control the decision-making process? We would be one of the few if not the only jurisdiction in North America, and definitely the only jurisdiction in Canada, that took that approach to transit financing. The province of Quebec just got out of transit financing completely. In British Columbia the local municipalities have been asking for more control over transit decisions and financing. They don't want to see it going the other way. So I'd say to the member for Richmond Centre: it's not downloading; it's listening to what municipalities are asking for. [Laughter.]

[8:15]

I notice another thing, while they're laughing over there. It was really interesting, and I'm really glad that they made the comments they did on SkyTrain and on transit. I heard it from the members for Vancouver-Quilchena, for Delta South and for Richmond Centre, and that was: transit to Richmond. Well, transit to Richmond is important.

D. Symons: Read the Blues.

M. Farnworth: True. We will read the Blues, and we will see.

Transit to Richmond is important, but to the people of the northeast sector -- Port Coquitlam and Coquitlam and Port Moody -- a transit line is not only essential, it is overdue, and it will be the priority as far as I am concerned.

D. Symons: Point of order. While I had the floor I made no reference to rapid transit in Richmond, and I would like that member to remove his remark indicating that I did make that reference. The Blues will prove it.

The Speaker: While the hon. member may feel aggrieved, the Chair did not hear anything disorderly.

M. Farnworth: If the member for Richmond Centre feels that his single implication did not imply that transit should go to Richmond next, I fully withdraw an implication that transit should go to Richmond next, and I take him asking me to make that withdrawal as his support that the next line should go to Coquitlam and Port Coquitlam. It's either one or the other.

An Hon. Member: How about North Vancouver?

M. Farnworth: You can walk across water.

An Hon. Member: You're darn right -- I'm a Liberal.

M. Farnworth: They raised the question of cross-border shopping. What is going to drive people to cross-border-shop is increasing the gas tax. That is what is going to drive people across the border, because we do have this deficit that has to be addressed. It was as I guess the member for Okanagan West.... This is where I'll make one of those references. It was one of those little booby traps that the previous administration left behind for this administration to deal with. We have to look at ways to deal with it. We could raise the gas tax, but that would drive people across the border to do shopping.

Interjections.

M. Farnworth: We could, as the member for Delta South said, increase fares. Over 40 percent of the people that ride transit at the present time make under $25,000 a year. The impact on them would be far greater than on those using a private automobile or those working in the areas where this transit tax would apply. I think that's really important to remember when we make our decisions on how we meet this challenge. Who are we affecting? Do we affect those who can least afford it, which is what the Liberals would have us do, or do we affect those who have the ability to pay? I think we have to affect those who have the ability to pay.

The decision on whether to implement this particular tax is up to the local authority, the transit commission. They will also determine the area to which it is to apply. We're encouraging decision-making at the local level, unlike my colleagues across the floor who think it should be centralized totally at the provincial level -- totally opposite to the direction in which every other transit jurisdiction in North America is moving.

This bill deals with a pressing issue, that of the deficit for the Whalley extension left behind by the

[ Page 3253 ]

previous administration. It deals with it not on the backs of those least able to pay, who are the majority of transit riders, but with those who can afford to pay. It's put in place at the local level by the local decision-making authority. What more could we ask for?

About the only other thing I want to say -- and I'll repeat it once again -- is that I'm so very, very glad that the members opposite will join me in supporting Coquitlam and Port Coquitlam for the next extension of transit.

V. Anderson: In response to the last speaker, I just have a very brief comment. I recognize that there was a problem and that a bill had to be paid, and I recognize that the government had to find a way to pay the bill. That goes without saying. Recognizing that the citizens of the province would like to be involved in the decision-making about how to pay it, the member over there asked what more one could do. One could consult with the people of the province, with the municipal councils in the local area, in making a decision. This isn't a decision just about the debt that has to be paid; this is a decision about the future direction of financing in this province.

Two major things are involved here, as I understand it. I was interested in the slipping into this bill in a very quiet way.... If you don't happen to read the explanation on the other side of the page and only read that there will be a slight amendment of the wording by taking out the word "except".... It's that one little word that changes it to put in the taxation of vacant land. It's that one word that makes the difference, and without the explanation you can completely overlook it.

I happen to have been brought up with the indoctrination that our taxing should be on vacant land and that when you make an improvement, you should not automatically be penalized because you make that improvement. So I know that argument. But that the government has slipped this in in such a fashion is, I think, totally unfair. They should have been more honest in presenting this to people.

The other item is that if they are going to change this method, if it's as successful as the government believes it will be in this current year, it's a question not only of what happens this year but of the bonanza which they are expecting to get from it in future years. They have managed in this government, as they do so often, to maintain control not at the municipal level, because they have given the opportunity to the municipal level if they bring their suggestion and it gets approval of the government every time they act on it.... The government has maintained control. They have not given control to the municipal government. If you had, that would have been one thing. This bill says: "We're giving you responsibility to pay. We'll give you a suggestion as to how you do it, and it's the only option you have. If you don't take it, you'll have this extra burden and the interest on top of it. Your debt will get greater and greater, because we have given the debt to you."

In answer to the last speaker, the one extra thing that this government could have done was present not one option, but a variety of options. If they really believe in consultation, they could go to the municipal governments and work out a solution together. That's the extra thing this government could do.

Hon. G. Clark: I'll be brief and just comment on a couple of remarks made by opposition members. First of all, the official opposition spokesperson for Finance said this would essentially penalize downtown Vancouver. I'm somewhat sympathetic to that. I am a Vancouver member and understand that concern. I notice that Len Traboulay suggested that if they did apply this tax, it should be applied regionwide. The Regional Transit Commission will determine both who gets taxed under this -- it is permissive -- and how much the tax is. They could also impose a variable tax, depending on various arguments. There is an argument for downtown to be taxed -- this is one that Toronto has used -- and it is that almost the entire several billion dollar transit system feeds the downtown. You could make that argument. Those are decisions which are delegated to the Regional Transit Commission.

Let me give you my own personal view on the question of downtown. I would like to see a parking-lot tax downtown coupled with a free bus downtown. That would deal with the question of equity concern and the argument that we're picking on downtown. Seattle has a free bus in downtown Seattle. Calgary has a free bus in downtown Calgary. Winnipeg has a form of free bus, and so do some other cities across North America. Many communities in North America have free bus transportation in the downtown core. That is not beyond our ability in British Columbia to pursue. It is a job for the Transit Commission and not for the government of the day.

If the Transit Commission wanted to, this mechanism allows -- and I can tell you that I personally would be in favour of this -- a tax on parking lots downtown, coupled with a free bus downtown. Then you're starting to dramatically change the focus of downtown transportation. I can tell you that if bus transportation in the downtown core were free, you would see a dramatic increase in ridership. That has positive benefits for the environment, congestion and transit ridership across the region generally. This legislation would enable that kind of linkage, which I think is good public and environmental policy. That's my personal view. It's up to the Transit Commission. We now have given them some tools to get on with the job.

That brings me to the next point, which is the official opposition spokesperson suggesting a 20 percent increase in fares. I respect the member for making his candid views known to the House, but I can tell you, candidly, that I'm opposed to that, because transit, generally, at the moment, has been largely a function of people who cannot afford private vehicle transportation. I could make a comment about the member's car, but I won't. I know that those who drive expensive vehicles may not be as sympathetic to public transit as we like. I don't mean to personalize it, hon. Speaker, genuinely.

It would cause me concern about equity to dramatically increase bus fares. There may be arguments for varying the bus fares and having differential rates and the like for various regions. I don't want to preclude

[ Page 3254 ]

that option for the Transit Commission to look at. But a dramatic increase across the board, I think, would be detrimental to the ridership and bad for the environment, and I don't think that would move public transportation in the direction we'd like. So this is a preferred option we're putting forward.

I want to assure members of the House, including the member opposite, that the Transit Commission controls fares, not the government of British Columbia. Even though I might publicly criticize them if they were to follow your direction, they do have the option of looking at the fare question. My preference is to go the other way, and that's to start linking tax increases with better and more affordable transportation, and the best place to start is downtown Vancouver.

[8:30]

Finally, I notice that the leader of the Social Credit Party suggested that a preference would be to tax all those served -- I guess property served -- in the entire transit region. The Transit Commission has said to me -- and some members have made reference to this -- that the Socreds forced them to adopt an expensive system, and they're not paying for it. I've said to them: "I'm sympathetic to the notion that the province cannot tell you what to do and then make you raise your taxes to pay for it." But they have said to me that they are prepared to look at their own tax base -- meaning the general property tax -- like every other municipality in Canada and in British Columbia, provided they have some control. I'm very sympathetic to that. I think they have a good point. If we're going to expect them to pay more of a share of transportation funding, then they should be given more authority and more control over the decision-making. That's the kind of discussion we're going into now.

They have the right to raise property taxes now. They've said, "No we're not doing that, because we have no influence. We just have a narrow control over service levels and fares, but really the province controls it." We need to give them more authority. That's their price for moving in their own tax jurisdiction. I'm sympathetic to that, and that's something which I hope will work its way out over the next year or two of discussions with the regional transit authority. We genuinely need to move in a much more rational way to give the region more control over those kinds of decisions, including the major capital decisions. There will always be significant funding from the province, and probably enhanced funding as we move into these major, billion-dollar capital spending projects. The senior government, the government of British Columbia, should always be at the table, but we need to link the regional control over the kinds of service improvements they might like.

A service improvement I would like is free buses in downtown Vancouver, or some variant on that theme, to provide more public transportation. In return for that, I think a small parking-lot levy is good environmental practice and makes a lot of sense. But I leave that to the Transit Commission. This is enabling legislation. My views are well known on the subject, but it's clearly not the end of the debate. That will be the subject of ongoing discussions.

I think this is a step in the right direction. It's only a step, hon. Speaker. I'm sure that over years to come there will be further legislative changes to try to enforce what I hope is a new and lasting governing structure so that we can get our funding act together and improve public transportation, particularly in the two metropolitan regions, southern Vancouver Island and the lower mainland.

Motion approved on division.

Bill 51, British Columbia Transit Amendment Act, 1992, read a second time and referred to a Committee of the Whole House for consideration at the next sitting of the House after today.

Hon. G. Clark: I call Committee of Supply.

The House in Committee of Supply B; E. Barnes in the chair.

ESTIMATES: MINISTRY OF HEALTH AND
MINISTRY RESPONSIBLE FOR SENIORS

On vote 48: minister's office, $365,941 (continued).

V. Anderson: Are we going to wait until the minister comes?

Hon. G. Clark: I'll take notes for her.

V. Anderson: I thought that you would be replying to the notes as well.

One of the areas that many people have been concerned about has been in the area of Pharmacare. They have found that the Pharmacare program has been one that they have appreciated in many ways and has been very supportive to them.

I'll repeat that for the benefit of the minister. I wanted to raise a question in the area of Pharmacare, because many of the people in the community that I'm aware of, those who have been on GAIN and senior citizens, in a variety of ways have had a great deal of support from the Pharmacare program. Some of the news reports lately have indicated that the support might be eroded or fade away. They're anxious about that and would like to hear. On the other hand, there is the concern of those who don't happen to be on a medical program that gives them Pharmacare support, those who don't happen to be on social services' GAIN support and the low income, fully employed person who finds that medical prescriptions are very expensive. I'm wondering what the direction in this budget is to give some security to people in this whole area of prescriptions and Pharmacare.

Hon. E. Cull: I've spoken on this report on numerous occasions. I have simply said that it is a report that was prepared by a committee. It has been in existence for a number of years now. The report has been released to the public, because I think it's important that the public is aware of such reports. The government is looking at it, but we have made abso-

[ Page 3255 ]

lutely no policy decisions. It is not our report, so we'll have a look at it. I referred it to the Seniors' Advisory Council, for what it's worth, to see if they're interested in making any comments on it. I have no intentions of taking policy direction from that report and will be doing my own Pharmacare review as time goes on. The information in that report will be considered, of course, as will many other studies that have been done on Pharmacare, including the comments of the royal commission.

The Chair: Hon. member, in light of what the minister has said, I think you should consider....

V. Anderson: I wasn't asking about her response to that report. I was just saying that's an anxiety out there. I was asking what is in her budget that has to deal with the Pharmacare program, apart from the report altogether, and what the projections are for it.

Hon. E. Cull: The budget for Pharmacare this year is $325,972,992.

V. Anderson: Those are the figures of the money, but what does that mean? What kind of access and opportunity will this extend in actual programming for people? The money doesn't mean much to people; it's the actual program in service that's important.

Hon. E. Cull: There has been no change in this program this year in terms of benefits or services covered. There is just an additional amount of money to meet increased drug costs and anticipated increases in demand for the coverage under Pharmacare. We have not had time in the last six months to review the Pharmacare program or to make any determination about changes to benefits.

D. Schreck: While we are on the topic of Pharmacare, it is my understanding that one of the reasons for increasing drug costs is what the federal government has done to lessen competition. Originally through what was called Bill C-22 and now once again, the federal government is looking at extending patent protection to a 20-year period.

I've received a letter from the president of Stanley Pharmaceuticals pointing out that Stanley Pharmaceuticals is an over-the-counter drug manufacturing firm and is the largest pharmaceutical company operating west of Ontario. That pharmaceutical company operates in my constituency, and I'm particularly concerned that it continues to thrive and do well not only in offering competition by keeping the price of drugs down, but also by creating local economic development opportunities.

The president of Stanley Pharmaceutical goes on in his letter to state:

"The federal government's proposals, in fact, are suggestive of a central Canadian bias British Columbians are far too familiar with. If you believe that the generic drug industry is important to British Columbia and are concerned with the risks to Canada's health care as a result of higher drug costs, then I encourage you, by communicating your support to the Hon. Michael Wilson, Minister of International Trade, and the Hon. Pierre Blais, Minister of Consumer and Corporate Affairs, to express your concern."

That extension is not only to a 20-year period of patent protection, but it extends it retroactively. Why would the federal government extend patent protection retroactively to December 20, 1991? I've had one suggestion by an informed source who tells me that by going retroactively, the federal government is eliminating generic competition in AZT, which would otherwise be eligible for manufacture and competition by the generic drug houses.

I ask the minister for the position of this government on opposing the attempts by the federal government to limit competition and drive generic drug manufacturing companies out of Canada and in particular out of North Vancouver.

Hon. E. Cull: I thank the member for his questions. This is a very important issue in the area of Pharmacare costs. As the member knows full well, the decision by the federal government, which was just recently announced, to extend patent protection has the ability to significantly raise drug costs right across Canada, not only by limiting the ability of the generic drug manufacturers to get into the act and produce lower-priced drugs, but because the federal prices review board has been virtually toothless in terms of establishing the introductory price of new drugs. It very proudly states that it's managed to keep the annual increase of drug prices to a reasonable level -- around inflation -- but it has totally missed the boat when drugs come in at a highly inflated level to begin with.

The sad part about it is that while Pharmacare costs have doubled in the last six years, since 1989 we have seen a drop in the research and development dollars in this province. That's gone from 3.6 percent to 3.1 percent, and we are clearly not getting our fair share of the benefits of the patent protection legislation here in British Columbia.

The Health ministers from across Canada have made it absolutely clear to the federal Health minister that this is unacceptable. Particularly unacceptable is the lack of provisions for ensuring that drugs already in the pipeline are protected from this. I would mention one in particular, an AIDS drug -- a generic AZT -- which would save this province and other provinces across Canada millions of dollars if we could use it. They have refused to let us do that; they have refused to consider our concerns about this. At my invitation, we will be meeting later this year to discuss how we will ensure that there are teeth put into the prices review board and that we will have a unified provincial front on this very important issue.

L. Reid: To continue the point raised by the minister, and for clarification, are we hearing that at this point you are not supporting research and development in the area of drugs? To take the position that generic drugs are cheaper -- well, we're not going to take issue with that. But at the end of the day, are we doing anything in terms of a viable economic strategy for research and development? Are we doing anything

[ Page 3256 ]

about creating job opportunities for university graduates in the area of research and development? Those are the issues, and to suggest on one hand that we're only going to pursue generic drugs is very shortsighted, in my view. I'd be interested in your comments.

[8:45]

Hon. E. Cull: The promise the federal government made to the provinces was that if we accepted an extension of the patent protection, we would benefit by research. The drug manufacturing companies promised Canada that we would see that research. It hasn't happened to the extent that it's been promised, and British Columbia has certainly not seen any of the benefits. We've certainly paid the costs, but the benefits have gone to Ontario and Quebec. Even in Ontario and Quebec they have not gone to the extent that was promised by the drug manufacturing companies.

Clearly we want to see research and development take place in British Columbia, and we want to see it take place in Canada. But at this point the companies seem to be having it all their way. They had the extension on their patent protection and they have an extension on their intellectual property rights, but they are not reciprocating by giving us any of the research and development. I think the federal government has sold us out on this one.

L. Reid: The concern that I raised in my question, hon. minister, was that this province needs to demonstrate some commitment to research and development. It's fine to stand up and say that we're being shortchanged, that we're not being treated the way other provinces are. That's an interesting comment. But at the end of the day, what are we doing as a province to invite drug companies to invest in British Columbia?

Hon. E. Cull: I assume that the member asked that question during the appropriate estimates of Economic Development and Advanced Education, Training and Technology.

L. Reid: I will suggest to the hon. minister that the same response was given. What are you doing as the Minister of Health regarding drug investment, which I believe comes under your mandate?

Deputy Chair: Shall vote 48 pass?

L. Reid: I find it really unfortunate that the questions we are putting forward are being shuffled off. This is the last estimate that this government is putting forward.

Interjection.

L. Reid: No, hon. minister, we had the same response at that point. At some point this government has to decide where the buck stops and actually answer a question.

To return to a discussion we had prior to Bill 51 being considered by this House this evening, we had a discussion regarding child care delivery in this province. What I would submit for your consideration this evening in terms of hospital wards that are undergoing bed closures.... Is there any commitment or consideration on behalf of your government to look at on-site child care for that space that, again, is already available in hospitals, has been paid for by the taxpayer once, and in fact could offer some reasonable service back to either the hospital workers or the community at large?

Hon. E. Cull: The member knows full well that I do not manage those hospitals; I'm not the administrator of those hospitals. I have no authority to tell the hospitals what to do with the space. Certainly the idea of when there becomes additional space in hospitals that it be used for community purposes, on-site child care is something that I have supported for many years. If the hospital boards, unions and employees involved decide that is something they wish to pursue, they will have my full support.

L. Reid: Can the minister tell us if there has been any change to the number of full-time-equivalent staff positions in her office since she became Minister of Health?

Hon. E. Cull: There have been no changes.

L. Reid: Does the number allocated for staffing costs currently represent any change in wage rates and/or benefit packages offered to the employees in her office since she took office?

Hon. E. Cull: No, it doesn't.

L. Reid: Has the minister taken any steps to ensure that current costs are being reduced, or at least controlled?

Hon. E. Cull: Yes, I have.

Deputy Chair: Before the hon. member continues, it would certainly assist us if you had a series of questions you'd like to state at one time. We could perhaps expedite the exchange. That's just a suggestion, of course.

L. Reid: If I might continue in some detail regarding the Medical Services Commission. The Medical Services Commission and Pharmacare are, to many British Columbians, the most important aspects of our health care system. The Medical Services Act, which governs the commission, is often referred to as the cornerstone of our health care system in British Columbia. The commission determines what services are covered, which physicians are covered and even which citizens are covered. The commission is responsible for paying doctors and other health care practitioners. It levies premiums and sets the levels of deductible. The Medical Services Commission probably has a greater impact on the way health care is run in this province than any other aspect of the Ministry of Health. Because the Medical Services Commission is so important to the delivery of health care, I would like to spend some time

[ Page 3257 ]

discussing with the minister her views on how the commission should operate and how she envisions it playing a role in the future of health care.

One of the most important functions of the Medical Services Commission is making decisions about which services will be covered and which will not be included in the plan. The idea of deinsuring some services has been thrown around a lot over the past few years. Can the minister tell us her views on deinsuring some services as a way to cut possible health care spending?

Hon. E. Cull: As the member knows full well, the structure of the Medical Services Commission and the power and mandate of the Medical Services Commission -- including the ability to look at what benefits are covered under the plan -- are matters contained in Bill 71. When Bill 71 becomes law, the authority to make those decisions will rest entirely with the commission.

L. Reid: The minister has made comments recently on the option of deinsuring cholesterol testing. I'd be interested in any further developments.

L. Reid: I'm sure there is lots of interest in my personal views on this subject, but, as I just stated, the intent of Bill 71 is to move the whole issue of what is an insured benefit under the Medical Services Plan from the purview of the ministry and the minister -- or the cabinet, for that matter -- and vest it with the Medical Services Commission. They are the ones, through the tripartite body, that will have a look at this issue.

The Chair: I should, for clarification to the committee, remind all members that under standing orders matters that are before the House in the form of legislation are not to be debated in committee. In light of the comments by the minister, I would suggest that matters contained under Bill 71 would fit that category.

L. Reid: In fact, minister, I was not asking your personal view. When you spoke on cholesterol testing recently, I don't think you cited it as your personal view. If you could expand on what was said, I'd be most appreciative.

Hon. E. Cull: With respect to cholesterol testing, I've raised questions about whether every British Columbian over the age of 13, or whatever, needs this. Obviously the answer to that is no. There are certain indications for cholesterol testing which make it an appropriate test -- lifestyle, medical and family history, etc. -- and I have simply suggested, as has been done in other provinces, that we might like to have a look at the appropriate indications. In that case, it would be a benefit under the Medical Services Plan. But for every test that everyone thinks they would like, if it's not medically required it perhaps should be reviewed for its suitability as a benefit under the plan.

L. Reid: As well as being interesting debate, I trust that some of these questions raised during estimates will also be instructive to the people who actually fund this ministry and the health care system. I'm speaking, minister, of the taxpayers in this province.

We touched a little on deinsured services. I'm interested to have you expand on something such as a heart transplant. Would the minister please describe how surgeons' fees for services are now paid in the matter of a heart transplant?

Hon. E. Cull: There is a fee schedule. I have no idea what the fee schedule for heart transplants is, but as with all of the other fee schedules within the Medical Services Plan, they are worked out by the B.C. Medical Association.

L. Reid: My purpose in asking was that it's my understanding that something like a heart transplant is currently not found in the fee-for-service guide. My question was: how does something such as that find its way into the guide, and how is a decision reached as to what the actual cost will be?

Hon. E. Cull: If there is a procedure that is not currently a benefit under the plan under our current arrangements, it's reviewed by the commission and a decision and recommendation are made as to whether it should be covered. Under the new provisions of Bill 71, that will be the responsibility of the new expanded commission.

L. Reid: If it is true that these services are not currently covered -- and suggesting that it may be at some point -- we do have individuals currently receiving heart transplants in the province, so somewhere there must be some knowledge as to how this is funded. If indeed that's true, if there is going to be an increase in that service -- and we can only assume that utilization will increase -- has there been any consideration given to increasing the dollars available for such a procedure?

Hon. E. Cull: The procedure is now covered under the plan, just to correct the member on that. The fee for doing the procedure, which, if you like, can be considered to be the wage -- to use a comparison that we might all understand -- paid to the physician for doing it, is something that is determined by the BCMA within the context of the overall fee schedule. There is a relative value of who gets paid what for what services. The overall amount for medical services is a global budget, which does take into consideration the needs of people in this province.

L. Reid: I also have some very specific questions regarding the pulsed dye laser treatment of port-wine stains. That is an issue for a number of British Columbians who have babies born with port-wine stains. They are now being told that this procedure is available, but it is not covered. It is a very current procedure. It is something that is very effective. It's less time-consuming, if you will, for the infant. It's less painful. In terms of skin grafts, there is less surgery. There are a lot of pluses in proceeding with something such as this. If this is going to be added to the list, what

[ Page 3258 ]

is the process to ensure that this becomes an insured service?

Hon. E. Cull: I can't confirm whether it is or is not an insured service. I'm sorry, I don't know all of the services that are insured under the Medical Services Plan. If there is a desire to have a service that is not covered now by the Medical Services Plan, it is reviewed by the Medical Services Commission. It is determined whether it is approved federally and whether it meets the criteria for medical necessity. Then it can be added to the plan. Benefits are added and taken off through periodic reviews.

L. Reid: Increasing utilization is obviously leading to higher costs for health care in this province. In fact, increasing utilization as a result of rising expectations, a growing population and an increase in the average age of British Columbians is the biggest issue facing health care. Can the minister outline for us her strategy for dealing with increased utilization of the health care system?

Hon. E. Cull: We are using a progressive funding formula for hospitals, which we canvassed at length in this chamber earlier in these estimates. With respect to medical utilization and the utilization of complementary practitioners, Bill 71 is the mechanism that we're using to do that.

L. Reid: If our goal is to at least understand utilization and, on behalf of the public, to understand how this works, can the minister outline for us a public education program so that recipients of the system -- the taxpayers -- have some sense of how it all comes together at the end of the day?

Hon. E. Cull: I'm unclear whether the member is asking for a public education campaign to inform British Columbians about what utilization is all about, or whether she is referring to the public education campaign that I have been talking about in the context of Bill 71. Is it the latter?

L. Reid: No, it's the former.

Hon. E. Cull: I'm not sure that British Columbians need to understand the definition of utilization. They really need to understand more what the appropriate use of the health care system is, which is what I'm more interested in spending education dollars on.

L. Reid: If that's the case, hon. minister, could you please outline what that education program will look like?

Hon. E. Cull: It's a responsibility that we are assigning to the Medical Services Commission under Bill 71.

L. Reid: In terms of assigning a responsibility, does the minister have criteria? Does the minister have a time-line? What are the objectives of such a program? I trust that anyone you would be assigning any responsibility to, whether it is a commission, a committee, or anything of that sort, would have some expectation for what that committee should deliver. Could you expand on that?

[9:00]

Hon. E. Cull: Certainly I have some expectations about what the public education campaign would look like. We would have objectives that it would inform the public and that it would have an impact on responsible use of the health care system which could be measured, but in terms of whether I am going to appoint a commission and prescribe to it exactly what it must do in the areas of public education.... If that's the case, why bother to give them the task in the first place?

L. Reid: It's a good question. What mechanisms has the minister put in place to monitor the effectiveness of the program? I think everyone in this chamber has looked in detail and most sincerely that any of these programs are only as good as their outcome. Has any consideration been given to how you will measure whether or not any of these programs are successful? I'm thinking in terms of you assigning this task to any committee. You must have some sense of how you're going to measure its success.

Hon. E. Cull: I assume the member is talking about measuring the success of the public education program. An essential part of developing public policy is to develop the evaluation and review process at the same time, and that will be part of their job.

L. Reid: As an educator I believe that schools are one of the best avenues to educate British Columbians about health care and the use of the health care system. The ministry has cancelled the "Learning for Living" program. Indeed, is this still the case? Will the minister reinstate this program because of the contribution it makes to public education about health care? What is its status? There seems to be much confusion in the media and with your officials as to whether this program is going forward across the province in a variety of schools, or if indeed it truly has been cancelled.

Hon. E. Cull: The "Learning for Living" curriculum is part of the Ministry of Education curriculum. I certainly haven't cancelled it and haven't heard that the Minister of Education has cancelled it. I agree with the member that schools are an effective means of education, and to the best of my knowledge we're still working through the schools to do that.

L. Reid: We're again being faced with the dilemma of a physician being patient advocate at the same time they're being asked to be the gatekeeper. How does the Minister of Health envision such a balance being struck? What kinds of safeguards would she put in place to ensure that physicians' responsibility to advocate on behalf of their patients is not undermined by their responsibility to control utilization of the system?

[ Page 3259 ]

Hon. E. Cull: One of the major ways that I'm doing that is opposing the BCMA's suggestion that we strip the reference to the Canada Health Act out of Bill 71.

L. Reid: Hon. Chair, I have some difficulty why it's somehow prudent for the hon. minister to raise Bill 71 in the discussion of estimates. I'd be interested in your opinion on that.

The Chair: Were you asking on a point of order?

L. Reid: I will raise a point of order, hon. Chair. Quite frankly, you have chastised this side of the House for engaging in something that is in the bailiwick of Bill 71. Surely that's a consistent message to all members of this House?

Hon. C. Gabelmann: If I may comment on the point of order raised by the member. Most of the member's questions are covered directly by legislation in front of this House. It's clear she hasn't read the bill. I think it's unfortunate that the minister has to make reference to Bill 71 on frequent occasions in response to members' questions that are clearly out of order.

Interjection.

The Chair: Are you responding to the point of order?

L. Reid: I am, frankly. I'm absolutely dismayed by the Attorney General's comments that somehow it's only convenient for that side of the House to respond to the bill. Frankly, this needs to be addressed. If both of these things have come before the House at the same time, there has to be an opportunity. My comment did not ask the minister to make any reference to Bill 71. I do not accept that that is a reasonable response to the question I posed.

The Chair: Thank you, hon. members. The points of order with respect to what's applicable in committee are serious. In attempting to assist both sides, there has been some latitude in terms of strictly enforcing the standing orders. Clearly, legislation and matters to do with future policy are not to be canvassed in Committee of Supply. The Chair would ask that future questions deal with matters before the committee to do with vote 48 and not to do with legislation that is, as yet, not completed.

H. De Jong: I won't get involved in the legislative matters, but I will get involved in some Health matters. In the Abbotsford-Matsqui area, which has had extensive growth over the last ten to 15 years, we still have the same health unit, the same space, as we did 15 to 20 years ago. The community has more than doubled -- in fact, tripled -- in population. A grant was given last year by the Minister of Health, I believe, to undertake a study for a new health unit. Could the minister bring us up to date on how far that study has gone and whether in fact the Abbotsford-Matsqui area will get a new health unit?

Hon. E. Cull: I accept the member's comments about the pressures that population growth have put on the Abbotsford-Matsqui area. It's something we've recognized through adjustments in our funding in many parts of our budget. I'm happy to tell the member that a new health unit is now in the planning stages, and it is in our five-year capital plan.

H. De Jong: That does give me some comfort. However, five years is a long time away. I would hope that the minister sees fit to do this in either the first or the second year of this five-year program, not after the five years type of thing.

The same applies to the MSA hospital, which has been a matter of concern for a number of years, in that we've outgrown the hospital. The surrounding hospitals are equally full -- Mission, Chilliwack and Langley -- especially because of a lot of seniors moving into the community, who often need more hospital care than the younger folks. Again I would like to ask the minister what progress is being made and what we can expect in this coming year or perhaps within the next couple of years.

Hon. E. Cull: I'm sorry, I don't have the capital planning information before me for the hospitals in that area, but I can say again that we are very aware of the regional inequities in the valley, where the population has grown much faster than almost anywhere else in the province -- with the exception, I guess, of the Kelowna area and the Okanagan, which have also experienced quite high growth rates, as well as some parts of Vancouver Island. So we are addressing the inequity problem. I'm sorry I can't tell you specifically about the hospital, but I know that if I give staff a little bit of time, we'll be able to get those figures for you.

H. De Jong: I appreciate the answer from the minister, and I look forward to getting those answers if not during the estimates then perhaps some other time.

I have a question regarding health inspections. I've had conversation and correspondence with the minister on this particular item. It deals with the approval of septic fields in the rural area, mainly in the farming communities and mainly on the floodplain areas, which are the lowland areas of Sumas, Matsqui and so on. There appears to be an increasing problem where some people who are applying to build a home can't get the building permit from the municipality until they have a permit from the health inspector, and in many cases these people have to wait in excess of a year. In fact, I was called by one today. He's now been waiting for more than a year while the neighbour across the road, who has similar soil conditions, has had approval within a year. Could the minister perhaps comment on that?

As well, the minister mentioned a think-tank in the last letter. I haven't heard anything since that time. Is this proceeding? Are private independent consultants, particularly West and Associates, who have been very

[ Page 3260 ]

busy in that area consulting people and the medical inspector to get something moving on this, allowed to participate on that think-tank?

Hon. E. Cull: The member brought this matter to my attention some time ago, as he has already mentioned, and he suggested to me that a think-tank might be a useful way of addressing the problems of septic tanks not functioning in an area of very poor soils and high water tables. I'm pleased to tell the member that that think-tank has been put together and has now met once. It also involves an independent consultant, Dayton and Knight, which was brought in to provide some independent advice; the Minister of Agriculture, representing the farming communities; the lower mainland health units; public health engineering; B.C. Environment; and Washington University. As you're even more aware than I am, the border is there but the water and the soils flow backwards and forwards across the borders. Anyway, they have met once and they're continuing to look for creative solutions, which is what you and I discussed when we talked about this problem. I understand that you have been forwarded the minutes of this meeting. If you haven't received them yet, I'll....

H. De Jong: No, I haven't.

Hon. E. Cull: I'll make sure my staff send you another copy.

Dr. Webb, in the letter that he did send you, has offered to meet with you and give you a full briefing on it. I would encourage you to do that, because I think he'll be able to answer your very specific questions.

H. De Jong: I have a final question on this subject, especially in light of the minister having all that knowledge surrounding her at the present time. This deals with interpretation of natural soil. I think that's one of the areas the health inspectors in the local area are hung up on. Natural soil has always been considered a natural type of soil, whether it was brought in, imported onto the site or.... Now the health inspector considers natural soil to be only that which has been placed on-site by nature. This is where I think the big problem has arisen. Imported natural soil has always worked in the past and in fact has helped to alleviate a lot of problems and has provided a good septic system. Again, some problem areas could be encountered if natural soil isn't considered in that light anymore, in terms of imported on-site soil.

Hon. E. Cull: The concerns the member raises about natural soil and the presence of natural soil on the site are governed under the regulations under the Health Act. I will not pretend to know enough about that kind of engineering and public health concern, but I can tell the member that the requirement, even in a large lot, is that there be a minimum of 18 inches of natural soil, which is soil found on the site, and that fill can be brought in up to a depth of four feet to deal with the problem. Those who know more about this than I do in terms of public health, engineering, hydrology and all of those other sciences tell us that the safe regulation to protect drinking water and to ensure that we're not polluting through septic fields is 18 inches of natural soil.

H. De Jong: Just a comment, if I may, in follow-up to what the minister said in terms of drinking water. We're talking about Sumas Prairie, which is totally on a domestic water supply system, so I think we have to be careful that we don't mix one with the other. Certainly having septic fields on a crop does not cause a problem for the domestic water supply.

The other point I'd like to make on the comments that the minister made in terms of water flowing back and forth into Washington across the border.... It should be noted that the land rises considerably going into Washington. Had it not done so, the Nooksack River would never have run into Canada. Thank you for the comments anyway.

L. Reid: I'm very interested in having the Minister of Health answer the questions, and certainly that seems to be shared by the Chair. These questions do not reflect on Bill 71. Frankly, I'm amazed that we're going to have an entire evening of debate where this minister takes refuge in the fact that Bill 71 precludes her answering the questions. I don't support that notion. Again, I would ask: does the minister believe it fair to put physicians in the position of having to serve both as gatekeepers of this system and as patient advocates? I trust that question can be answered exclusive of Bill 71.

[9:15]

The Chair: Before the minister responds, I would just like to make a comment for the benefit of the committee. The minister has stated that the questions asked on this subject were germane to Bill 71 and were in effect out of order. I am not in a position to determine precisely what falls under the minister's responsibility. If the minister suggests that a matter falls under an bill which is before the House, the Chair has to assume that that is the position the minister is taking and will have to determine whether or not the matter is being pursued notwithstanding, in which case I would have to rule it out of order. Just being guided by that, the minister's responses will determine the ability of the Chair to keep order in committee.

Hon. E. Cull: Thank you for that guidance, Mr.Chair. I think if we stay away from matters currently in front of the House in Bill 71, we'll be able to discuss the Medical Services Plan in sufficient detail for the estimates.

The question was asked as to whether physicians should be the gatekeepers. They are the gatekeepers, and they are the primary caregivers. In almost all cases -- with a few exceptions, which I'm sure the member is aware of -- they are the first point of entry into the system. They are the ones who determine whether medical care is needed, whether further care is needed, whether referral to a specialist is needed or whether tests are needed. They are in fact the entry point, and unless the member is suggesting that we have another

[ Page 3261 ]

entry point -- and if she does, I'd be quite interested in hearing it -- that is the system under which we currently operate.

L. Reid: What I was trusting would come out of this discussion, hon. minister, is that utilization in this province is driven by patients as much as by physicians. You obviously do not share that view. You only see physicians as the entry point. But I can tell you that many physicians....

D. Schreck: On a point of order. The hon. member may not like the rules of the House, but they are the rules of the House. We are continually returning to subject matter that was canvassed for days under Bill 71. It is clearly out of order.

The Chair: Thank you, hon. member, for that point of order.

The member would please continue, keeping in mind the line of departure with respect to matters that are in order and out of order. I don't wish to restrict the member's ability to get information, but there are problems when a matter is pursued to the point that it becomes repetitive, notwithstanding the member's feeling that the matter should be in order. If it is not being addressed by the minister, for whatever reason, the Chair has to recognize that as being the extent of the minister's response.

L. Reid: Thank you, hon. Chair. I appreciate the comments.

To return to my question in very simple detail, I know of very few physicians, if any, who stand on street corners and canvass business. So I am taking issue with the minister's response that they are the entry point. People seek out physicians when they are unwell.

Again, to my earlier point about education: what happens, in your view, in terms of sharing the responsibility for utilization in this province? That is the question that I want to get at this evening.

Hon. E. Cull: Mr. Chair, I asked your guidance on this one, because my response is going to be exactly the same as the one I gave earlier this afternoon when I concluded second reading debate on Bill 71. I said quite clearly that utilization is a shared responsibility between the doctor and patient and that we have to have an education campaign to deal with both parties. I'm afraid that if I elaborate much further, I am going to be dwelling on matters that we will be getting into in committee stage.

The Chair: Thank you, hon. minister.

I would ask the member for Richmond East if other matters could be canvassed with respect to the issues before us and if we might leave that matter in light of the fact that the minister has made her statements.

A. Warnke: On a point of order, I think that the question posed by my colleague for Richmond East was rather specific and not in any way related to Bill 71. I'm surprised at the answer given by the minister, considering that it was specifically on an aspect of education. If the minister or the House recalls, we did not pursue this particular aspect throughout second reading.

The Chair: Thank you, hon. member, for your point of order. The problem that the Chair has is pursuing a matter that is clearly being considered inappropriate by the minister. If we're guided by the standing orders, we recognize that matters that are persistently pursued to a point that they become repetitive are out of order in terms of the ability of the committee to progress. With the greatest of respect to the member, I would ask that she pursue other matters. The Chair would so rule that the matter be out of order at this time.

L. Reid: Before this government was elected it promised to abolish health care premiums quickly after it took office. Aside from some off-the-cuff remarks from the Minister of Finance, we've heard next to nothing about this government's intention to live up to this promise. Can the minister tell us if there is a plan to abolish premiums for health care? Is it in the works? If so, what is its time-line? What is being considered to make up for the loss of revenue to the Ministry of Health?

Hon. E. Cull: While I have a great deal of interest in the whole question of premiums, particularly the impact of paying premiums on the welfare and health of people in this province, the plans to eliminate premiums, to replace them, are clearly a matter that has to be canvassed in Finance estimates as the responsibility of the Minister of Finance.

L. Reid: If indeed I can receive answers to the questions I have about premiums at some later date, I'd be most appreciative of that.

Continuing in that line of questioning, can the minister tell us her position on the concept of replacing premiums and making up for loss of revenue through the tax system? Does she think this should be dedicated money? It is posed specifically to the Minister of Health, not the Minister of Finance.

Hon. E. Cull: The opposition critic would now have the Minister of Health setting tax policy in this province. While I appreciate her confidence in my ability to take on that job, I am absolutely burdened with dealing with the problems of the Ministry of Health. The question of taxation, whether revenue is dedicated to a ministry or what we do with premiums is a matter that the Minister of Finance is determining.

The Chair: I think, again, that that is an indication to the member that this is a matter not strictly falling under the Ministry of Health. Would the member please proceed.

L. Reid: Can the minister tell us what effect she believes premiums will have on accessibility to the health care system? I believe accessibility, hon. minister, falls completely within your bailiwick.

[ Page 3262 ]

Hon. E. Cull: Thank you for a question, which is within my responsibility. We have looked at the coverage of medicare through the premium system. The advice from my staff is that somewhere between 1 and 2 percent of British Columbians are not covered by premiums. That amount, while very small, does concern me. The majority of those people who are not covered are either mentally ill or people who are unable to maintain premiums. We are looking at ways to ensure that they don't inadvertently fall off of medicare because they are unable, through their illness, to stay on the system.

They are frequently students who graduate. They leave their parents' program, and they become independent and are supposed to enrol themselves. We have now started a program of advising all graduating students of the need to register for themselves. The other people who are left off, quite frequently, are people who decide that the premiums are onerous, even though there is premium assistance. They decide not to pay them and to divert their money to other things they feel are a higher priority -- probably paying the rent and putting food on the table -- which is why premiums are a concern to me and to the government. We are very lenient when it comes to putting people back on the system. They have the opportunity to pay back the premiums if they have failed to do so for a period of time, and they have an opportunity to retroactively claim premium assistance.

L. Reid: Does this minister believe that making the payment of premiums a requirement for medicare coverage contravenes the Canada Health Act? If not, why not?

The Chair: Hon. member, I would just like to try again to make one important point. The purpose of the committee is to elicit information specific to a minister's responsibility. When it gets to matters of opinion, theoretical points of view, etc., the minister may or may not provide such a point of view. If the questions could be directed to specific functions and responsibilities of the minister, I think that would be much more in order than if it is an open-ended seeking of an opinion.

A. Cowie: I have a couple of questions regarding Shaughnessy Hospital and the planning of Shaughnessy, which the minister is directly responsible for. It's my understanding that, in the past, Shaughnessy was being planned as a central facility. They have the Children's Hospital and the veterans' hospital, and it's certainly a central location near public transit with good helicopter emergency service. Although it's one of the largest hospitals in North America -- if you include the Vancouver General Hospital complex with that -- the idea was to centralize specialty services. Is that the plan of the future? Are we going to see specialty services dispersed to Richmond, Delta, UBC and other surrounding areas?

Hon. E. Cull: The planning for Shaughnessy Hospital is still in progress. I can't answer the question as to what will be at the end of the plan, because it is still being worked on. As you know, the building is very old. It's quite inadequate, so there is a plan to pull the building down and rebuild a number of beds. The number of beds has not yet been determined. Grace, Children's and Shaughnessy are working with the city of Vancouver to determine the appropriate floor-space ratio -- a term I don't need to interpret for this member -- as they determine exactly what can be rebuilt on that site.

A number of things have been suggested, including making it a focus for family practice as opposed to specialties. At this point, there have been no final decisions on that. It's something we're actively working on this year in conjunction with the hospitals.

A. Cowie: I personally have always felt that that was the proper place for centralization, regardless of what the surrounding residents felt. The hospital was there before many of the houses in the surrounding area. I recognize that there are concerns that have to be addressed.

My concern with this is the understanding that the number of beds is being reduced, and some of the specialty services are going to UBC. I've always considered UBC hospital an interesting hospital in that it's near the doctors at the university, but I think it also adds to the problem of more and more people going through my riding to get there, and more and more hospital workers who live in Surrey going through my riding to get there. In addition, over the next few years, we'll see another 10,000 students going through there. Undoubtedly, one of these days the people in my riding are going to wake up and realize that there is a problem. I wonder how much emphasis is going to be put on moving some of these specialty services to UBC either to please the doctors or for whatever other reason that they don't have the facilities elsewhere.

[9:30]

Hon. E. Cull: I don't think anybody would accuse me these days of moving services to please doctors.

The whole question of beds and facilities in the Vancouver area is one that has to be looked at comprehensively. In talking to this member, who is also a planner, I know he will understand that and will probably have the same passion for doing it in the fashion that I want to see it done. There is no point in dealing with it hospital by hospital in Vancouver; we have to look at the needs of the region. We don't want to see patients or employees having to travel from one end of the Vancouver area to the other because services are located away from where the population base is. For that reason, we are putting more resources in Richmond and Surrey this year to meet the growing need down there, and we will be looking at the total number of beds required in the city of Vancouver. There are probably more beds there now than are needed and, in fact, used. It's always interesting that when you look at beds in hospitals, a lot of the beds are still on the books as being open, when in fact they are being used as office space by administrative staff, etc. In consultation with the hospitals, we're having a look at the whole picture in the Vancouver area. I understand exactly what you're

[ Page 3263 ]

saying. Let's put the services closer to the centre where the people and the major transportation links are, not simply where there happens to be a university, when it's away from the bulk of the population. I will be bearing that in mind as I'm reflecting on the recommendations of that study.

A. Cowie: I was at a workshop two weeks ago Saturday in Vancouver. I went to the hospital services portion so that I could learn a bit about where the need was. It was very interesting that at least three-quarters of the people at that portion of the workshop were hospital administrators, so I'm not too sure I got a rounded point of view. A couple of people at that workshop expressed the opinion that hospital workers and the public as a whole should be totally involved in some way with this decision to decentralize or change jobs. Some of these people would have to move their locations to follow the job, and there was a concern that they were not heavily involved. I take it that the minister has a plan for involving the Hospital Employees' Union, other workers in the hospital field and the citizens.

Hon. E. Cull: With respect to the hospital unions, again, we talked about it earlier in the estimates. Yes, there is a labour adjustment strategy being developed with the major unions. Besides the hospital-to-community shift which we've talked about at length, there is also the hospital-to-hospital shift, because some hospitals are reducing their numbers of beds, and others in the valley will be increasing theirs. Richmond, I believe, is opening 50 beds later this year. That is one example of a shift that may take place. Some of those beds may in fact come from Shaughnessy Hospital in terms of beds being closed there and opened in the valley. There is a strategy being built right now to ensure the smooth transition of employees who wish to make that move from one institution to the other.

With respect to involving the community in any planning for the hospital, there is the regular community planning process, but I think I hear you saying that in hospital planning we need perhaps to have a look at involving communities a bit more in what facilities are built, how they are built and how they are changed over time. It's precisely my goal with respect to increasing health care planning under the royal commission.

A. Cowie: There was some discussion on this. I can remember the administrator leading the workshop -- Greg Stump, I think his name was; he's the administrator for the Greater Vancouver Regional District, and he's been there a long time. He's very knowledgeable. He wasn't able to deal with a number of the questions, because he had to restrict himself to hospitals and hospital planning. One of the real problems at the meeting was that they weren't able to deal with the complete service. I wonder if the minister would just like to comment on that briefly.

Hon. E. Cull: My deputy has just pointed out to me that the hon. member and I are talking the same language, and I said that was because we're both planners. I think my concerns to integrate health care services and to do more long-range planning for them at a community and regional level are entirely in line with your questioning, and we do not have and have not had in place in this province any mechanism for doing that. I'm trying to find a way to change that. That's part of the work that we're doing right now with respect to the royal commission and the whole concept of integrating and regionalizing services. We need to plan across the health care system, community to acute care, and we need to do some forward thinking on it.

A. Cowie: I thank the minister for answering the questions, and if she needs any help we could both gang up on her deputy....

R. Chisholm: I'm going to bounce around here, hon. minister, for a second. I just have about three or four questions. One is on chemotherapy. The B.C. Cancer Agency has an outreach program that permits cancer patients to be treated in their own communities after an initial assessment at the BCCA centre. The community oncology program has been a positive step towards bringing treatment closer to home. Smaller community hospitals such as Chilliwack are not being reimbursed for staff time required to dispense or administer required drug doses, although the cost of the drugs themselves is covered. Is there any plan in the future to take care of the administrative and staff costs?

Hon. E. Cull: I can agree with the member that the program is a success. In fact, it's being expanded this year. Unfortunately, I don't know the answer to whether the administrative costs are part of the global budget of hospitals -- in which case the answer would be no, we would expect hospitals to provide those services under their global budget -- or whether there is additional funding made available because the services are part of the B.C. Cancer Agency and not part of the hospital. Happy to get back to you.

R. Chisholm: At the present time, drug costs for extended-care residents are met through the global hospital budget for pharmaceuticals supplied by the hospital pharmacy. Drugs for intermediate-care residents are generally supplied through retail pharmacies in the community and paid for through the provincial Pharmacare program. If this problem is not addressed soon, patients in extended-care beds in Heritage Village will require supply and reimbursement from one system, while those who are classified as intermediate-care will be supplied and paid for from another. To make the situation even worse, residents may change their status from intermediate care to extended care and back again during the year, which will compound the headaches in the administration of the two separate billing systems. Is there anything planned for the future to straighten this situation out?

Hon. E. Cull: I'm not sure whether the member in reading the question missed a line. He referred to "if this problem is not fixed," and I didn't hear the description of the problem.

[ Page 3264 ]

R. Chisholm: To make the situation even worse, residents may change their status from intermediate care to extended care and back and forth throughout the year. This complicates the administrative billings in the two separate billing systems. The question is: do you foresee rectifying or remedying this situation so it's not quite so complicated between the two systems?

Hon. E. Cull: I listened very carefully to the member, and he said that to make the situation even worse, patients change between extended care and intermediate care. Which situation is being made worse? I'm still not clear what the problem is. I think there's something missing here.

R. Chisholm: It's Pharmacare. You have IC and EC, and they're going back and forth. The problem is that now you have complicated it because the patient is between two systems, which is an administrative nightmare. I'm just wondering if this is going to be straightened out or eased for the hospitals.

Hon. E. Cull: I'm afraid that I still haven't got a clear picture of what the problem is. The patients go backwards and forwards; they are covered for drugs in one system or the other. I'm not aware that there's a problem. People do change facilities. There's coverage for drugs that may be under different plans, but the hospital is fully covered, and in the intermediate-care program, there is plan B.

R. Chisholm: I realize that they're covered. I'm trying to get an answer as to whether you're going to try to straighten out and ease the administrative burden for the hospitals and agencies involved. We'll leave that one for a while, and I'll send you a letter on it. That might be the best way of approaching it.

I'll go on to another question. At the present time the hospital is engaged in several pilot programs such as the better breathers program, the established diabetics program and the maternal health program. There is always room for some expansion. We may be seeking funding support for health promotion projects through the UBC department of family practice residency program, although this is yet to be finalized. Is there any extra money in these programs this year?

Hon. E. Cull: We don't fund the UBC programs, so you'd have to ask that directly of the university.

R. Chisholm: Sex education is currently being considered by the hospitals, but it is not part of their mandate. Do you see a future where you would be working with the Ministry of Education on sex education in our communities?

Hon. E. Cull: We're already very actively involved in sex education through our public health units.

D. Symons: A few questions to the minister. There has been a great influx of people from other countries into Canada in the last few years. A good number of them have established residence here, but they frequently return to their country of origin to continue their business or work there. There has been some concerns expressed to me about the way in which they might be using the Medical Services Plan of B.C. while they're offshore. I am wondering if the minister could tell us whether money is sent to cover medical expenses in these countries where the people might be basically residents, although they have a residence established here but may not be living here that much.

Hon. E. Cull: The definition of a resident is in the existing Medical Service Act. You have to be resident in the province for at least six months of the year to be considered a resident. I don't want to stray into dangerous waters, but when we have Bill 71 we will be able to check on whether any people are doing exactly what you have suggested they may be doing.

D. Symons: I'm wondering how one determines residency. You can purchase a house, rent it out and return to another country. How are you determining whether they actually have that six-month residency requirement? I'm not sure whether the bill you referred to would clear up the problem of residency. It might clear up the doctor's records, but it wouldn't clear up the problem of what the residency really was when the person goes to the doctor or hospital.

Hon. E. Cull: The new bill does in fact deal with beneficiaries and residencies. There are provisions in there that I'm sure we'll discuss at length in committee stage.

D. Symons: I wonder if the hon. minister might enlighten me as to which countries receive most of the offshore -- out-of-Canada or out-of-B.C. -- payments for medical services performed outside Canada? What would the top three countries be?

Hon. E. Cull: We don't provide services offshore. If someone is not in this province and they require medical care outside the province, it has to be established as having been emergency care. There would be an investigation to make sure that the person was not living in that other country. I'm not aware of many instances at all such as are raised by the member.

D. Symons: I was referring to an emergency situation that may take place. I had the story given to me by a person who was concerned about it. It apparently involved a situation with a neighbour. I'd suspect from the way he told the story that somebody was using the emergency situation but actually took a child in that was probably a nephew -- or a niece -- and claimed him as their son in some other country. They then had B.C. medical services pay for it. Is this possible? If it is possible, how can we control that sort of thing? If they need an appendectomy or an operation of some sort, can you take your extended family in and call it your family somehow?

[9:45]

[ Page 3265 ]

Hon. E. Cull: I think it would be highly unlikely that people would be rushing in and out of the country every time they thought they might have a medical emergency. We don't cover non-emergency situations when people are out of the country. If such was happening, it would be fraud, and they would be liable to be charged and have the moneys recovered in due process.

D. Symons: I did ask this question near the beginning. I'm wondering if you might tell me where these emergency operations take place. Which countries are recipients of the fees? Would they go directly to the doctor or to the hospital? Is it identifiable by country of origin, so to speak?

Hon. E. Cull: I don't have a full listing here with me tonight, but my guess would be that the top country for emergency care provided to B.C. residents when they are out of the country would be the United States.

V. Anderson: A number of people who are in business organizations or education are able to get extended care over and above the regular medical program. Probably a lot of the people who are of lower or even middle income are not able to do this, because they're not in group plans. Is there any possibility that the government might consider an extended care program that people could take advantage of who are currently only covered under the basic program. As people travel, this becomes an increasing.... Particularly as they go back and forth across to the States, if they get caught there, as a community they are in great difficulty because of the expenses. If some kind of extensive extended care program were generally available, it might be advantageous to everyone.

Hon. E. Cull: I'm trying to cast back to the last time I travelled out of British Columbia and had to buy extra insurance to cover myself. It was very inexpensive for the period of time that I was away on a vacation. If the member is asking whether we are planning to put in place an insurance scheme to cover out-of-province medical costs that are not emergency, the answer is no. We have other priorities here in British Columbia.

V. Anderson: I'll move to another kind of care. This was asked in part by one of our other members earlier. I think the minister took part of the question on notice to check into, and it had to do with palliative care. There's a great deal of concern about the types of palliative care that may be available and where they're available. Some hospitals throughout the communities have been developing palliative care programs, primarily because of interested community volunteers. On the other hand, it's not available every place. I know there's been some discussion of making palliative care facilities available in the home as well as in hospital or community settings. Could you explain to us what is being planned in those areas in palliative care?

Hon. E. Cull: The member for Langley asked that question, I think on the first or second night of estimates, and I came back the next night and answered it in full.

L. Reid: I have a question regarding the task force that's currently underway at the Prince Rupert Hospital. From my understanding -- again this comes from correspondence directed to the official opposition Health critic -- the task force is to investigate the staff's concerns. One of the staff's biggest concerns at the Prince Rupert Hospital is the minister's plan to import workers while staff are being laid off. Can the minister tell us if this issue will be on the task force agenda and if not, why not?

Hon. E. Cull: It won't be on the agenda, because the minister has no plans to import workers.

L. Reid: I can tell you that that response will warm the hearts of the folks in Prince Rupert, because that is not their understanding.

I would like to move in the next few moments to questions regarding mental health service delivery in this province. My concerns are in looking at the current situation that British Columbians believe they face with the downsizing of the Riverview institution. Their sense to date is that that process has not been undertaken well and that there are some serious problems. Certainly the municipalities which surround the institution of Riverview believe they are now facing problems that are well above and beyond the call of duty. They simply do not have the resources in place to handle the downsizing of Riverview. They're not committed to this new plan.

Maybe it's something you can advise them on in terms of how it's going to be improved upon and how best those services are going to be delivered. Right now I can tell you that this is probably the number two issue before the opposition in terms of the number of folks who have immediate concerns regarding this and have written to us about how mental health is going to be handled in this province.

Hon. E. Cull: As far as I'm concerned, in the community health area it is the number one issue that we have to deal with. The former government had an appalling record on mental health. They ignored the mentally ill and downsized without providing any community services. Last year, when I sat on that side of the House, we read letters into the record, talking about how neglected these people have been. I have to tell you that the thing I am most proud of in this budget is the $53 million that we have put into mental health this year. That is almost half of the additional funds that have gone into community health. It's a 25 percent increase.

When it comes to the particulars of Riverview and downsizing, we've made two significant initiatives. One is that we are moving to a community board with respect to Riverview Hospital that will no longer be dominated by government people. It will be composed of mental health consumers, families and major agencies supporting them. It will be the first time that consumers have had a direct say in the provision of services that affect them.

[ Page 3266 ]

[D. Streifel in the chair.]

In addition this year, as part of the continuing transition with Riverview, as opposed to earlier years.... Unfortunately there are no members of the third party in the House tonight, but as opposed to what they did, we are providing $3 million of transition money to provide parallel community services for 100 patients who will be transferring from Riverview to the community this year. Of that $53 million, $11.3 million is for supportive housing and rehabilitation programs that will start dealing with the people who are unfortunately already out on the streets.

L. Reid: To continue this with the hon. minister, I certainly share the sentiments she has expressed. The delivery of mental health services in my municipality is significant, and I'm not sure that this an issue because of its proximity geographically to Riverview, or if the lower mainland offers more services. It's a significant problem. I've had numerous dealings with the Richmond branch of the Canadian Mental Health Association, because even the issues of housing cause tremendous concern in my riding of Richmond East. We simply don't have the services available, and we're not on board, if you will, in terms of what direction the Minister of Health wishes us to go as a municipality. I believe that the individuals who are delivering mental health services in the municipality of Richmond are doing the very best they can, but they're not clear on what the next step is or what direction we're headed in. If you could elaborate on that in terms of the number of dollars that go to community care and what the community care for mental health patients will look like, that is an issue for my constituents.

Hon. E. Cull: The funds for mental health services in Richmond are administered through the Greater Vancouver Mental Health Service Society; I am sure the member is aware of that. Clearly, the amount of money that we have put in this year, which is significant, is a major increase. This is the first time that mental health has had this kind of increase in funding, actually, with considerable emphasis -- about a quarter of that money -- going to housing, $5 million to emergency response teams, another $4 million for acute and preventive services, $5 million for seniors' crisis support and another $3 million for consumer and family involvement and education. Then there is the money I've already mentioned to you with respect to transition funding for Riverview.

Also, there is almost $1.5 million going directly into Richmond in the mental health area itself. This is an area that has been neglected and needs more attention, but I have to tell the member that the way we have been able to achieve this very significant transfer of funding is by doing something that her party has been opposing, which is by holding the line on increases in the Medical Services Plan.

L. Reid: Please know that we had no issue, hon. minister, with the budget. We are looking at how the dollars are allocated, which is why I think this estimates process can be a meaningful exercise.

One of the most poignant discussions I had with a constituent was with a gentleman close to 70 who believes he has spent the last 30 years of his life trying to receive adequate service for his son. His son is now housed, if you will, in Richmond, and that is his terminology. However, he came to my office and his request to me was: "You need to ask the Minister of Health what my son's day looks like." He now lives in my riding, but he sits in his room all day long. There isn't any support. There isn't any service. There isn't any expectation that it'll ever be any different. As well as putting dollars towards all the items you've just mentioned, instruct the opposition as to how we go back and suggest that having people closer to home -- in the community, if you will -- somehow is delivering a better program. That is the overriding concern; that is the umbrella concern we have about mental health. We're not opposed to community care; it's appropriate that they be in the community. But once they're there, we have to be able to say that we are providing programs that are productive.

Hon. E. Cull: As I've said, we've made a significant increase in funding mental health services this year. This is the end of June. The money's been available since April 1. We can't change the world for the mentally ill overnight, but we certainly can make a significant step in that direction, and we're doing that right now.

Again, I think your constituent in Richmond should get in touch with my staff in that area, because one of the things we've increased funding for this year is exactly the kind of thing you're talking about: expanded clubhouse activity and skill development programs to support individuals in communities, support for the development of psychiatric staff at the hospital, more clinical staff to provide assessment and intervention, additional housing, and expanded emergency response services. All of those are for adults with serious mental illnesses.

I could go on and tell you about seniors' and youth services, which have also expanded in your community.

L. Reid: Again, the issue is a little bit more than the availability of service; it's more than whether or not those services are available. It is participation. Certainly we can have all the services in the world, but if this young man sits in his house or in a clubhouse, what are we doing differently? What is our vision for mental health care? The father of this child believes that nothing has changed. Convince this House, convince British Columbians, that we are going to have some kind of vision for how we deliver mental health care. If it's a question of sitting in Riverview or sitting in the community, how are we looking to do things differently?

Hon. E. Cull: I think the major difference between this government and what was happening before is that an incredible network of community agencies has existed over the last number of years -- Friends of 

[ Page 3267 ]

Schizophrenics and the Canadian Mental Health Association, just to name the two big ones -- that has provided support, encouragement, network services and all kinds of developmental services to people with mental illness. The major difference is that there were no services to take those people to, because there was no government funding to provide those services. We will now provide those services. Through that community process that exists, which we are working hand-in-hand with to determine exactly what services are most appropriate in each community, we will make that link that the member is looking for.

L. Reid: I would very much like to carry that message back to my constituent, when he looks at services in the community and sees his son behaving in exactly the same way: yes, we do have a grander vision for mental health care in this province. I trust we will evolve into that as we go.

[10:00]

Constituents who contact my office also have real questions about the future of Riverview. We understand that it's being downsized. What is the plan? What will it be maintained at in terms of population? Where do we go over the next five to ten years with that institution?

Hon. E. Cull: There's a plan to redevelop beds in the lower mainland, so that there will be 300 beds in the lower mainland, 100 beds somewhere in the interior at a location that has not yet been determined, and another 100 beds on Vancouver Island.

L. Reid: For clarification, are we having 100 beds in the lower mainland and 100 beds on the Island?

Hon. E. Cull: No, 300 beds in the lower mainland, 100 on the Island and 100 in the interior.

L. Reid: Hon. minister, could you elaborate on when that time line will be in place?

Hon. E. Cull: As I mentioned earlier, this year we're moving 100 beds into the community. It's going to take a bit of time to do this. The time horizon for the full completion of the project is probably eight years, but it will take some time to make the community beds available. As the member knows, it takes some time to actually build new facilities. We're looking at an eight-year time horizon for this. We want to do this well.

L. Reid: At the end of the time line, whether it be eight years or less, will Riverview still be operational, or will it be eliminated in the grand scheme of things?

Hon. E. Cull: I hope that what replaces Riverview will not be recognizable as Riverview. If the member has visited it, she will know exactly why I'm making those comments. There will be 300 psychiatric hospital beds of much superior quality in the lower mainland.

L. Reid: For my information, then, at the end of this time line, will we not have anybody at the current Riverview site?

Hon. E. Cull: The location of the lower mainland beds hasn't been determined yet. Riverview, of course, is one of the sites that is being considered. It's a very large and beautiful site, with a lot of -- I would call them mental health amenities -- trees and beauty. It certainly is being looked at as one of the possibilities.

L. Reid: The Mental Health Consultation Report recommended that methods should be developed to coordinate community groups and others within the network of community health services and mental health services. You have touched on that, and I believe the direction we're going in is the direction we do want to pursue. If I can just ask for specific examples, what measures is the minister undertaking to carry out the recommendations from the Mental Health Consultation Report

Hon. E. Cull: A provincial advisory committee on mental health has been established that is working on the recommendations coming out of the paper the member referred to. There are also regional advisory committees and, in some cases, local ones as well.

L. Reid: We've certainly touched on community care in lots of detail. Do you have specific plans as it relates to the delivery of mental health?

Hon. E. Cull: I'm a little puzzled by the question. The answer is yes. In fact, all of the programs that I've listed to the member -- in terms of the dollars for various types of programs that I ran through very quickly a few minutes ago -- are community-based programs. To distinguish the community-based programs from the rest, the other mental health programs are provided through hospitals in the hospital budget, through psychiatric programs within the hospital or through the Riverview hospital replacement program, which you could distinguish from community-based programs, although moving 100 beds to the Island and another 100 beds to the interior will be bringing those beds a little closer to home.

L. Reid: One of the other concerns that seems to continue to come forward, no matter what area of the province you visit -- certainly in my hospital tours and tours of community care facilities throughout this province -- is the lack of psychiatric intervention services. In terms of coordinating a new vision for community health care, have we looked at communicating that intention -- i.e., that we want to move into the community with the existing psychiatric services?

Hon. E. Cull: Yes, there have been a lot of discussions going on about the future of mental health care in this province. I have to tell the member that one of the most difficult problems we have to overcome is getting psychiatrists to provide this kind of care in hospitals, as opposed to treating patients in their

[ Page 3268 ]

offices. We have a lot of difficulty, even in your own community of Richmond, in getting psychiatrists to do the kind of really tough mental health work that has to be done in hospitals, where people come in in a pretty bad state and are very difficult to deal with.

L. Reid: Your point is well taken, and certainly psychiatry seems to be a burning issue that we don't have a handle on. The reduction of psychiatrists in this province is an issue. However, if we're leading into community care, as is the suggestion, we are looking for psychiatrists who would wish to practise their craft, if you will, in the community. So we're not necessarily looking to put those practitioners in hospitals, but to have them work in a situation that's much more independent than a hospital setting. That probably raises more concern for their own personal safety in dealing with mentally ill patients. It may be difficult -- and I'm sure it is -- to secure that service in hospitals. My thinking is that it's going to be doubly difficult in the community when psychiatrists will often be working alone.

Hon. E. Cull: The services provided to the mentally ill are not only provided by psychiatrists but by a vast array of workers in the mental health field. We already have quite a number of people working throughout British Columbia in mental health centres of the ministry. As you know, a great deal of the additional staff we'll be hiring will also be in that area. My reference to psychiatrists is not so much that they're working in the community and we can't get them into the hospitals, but that they're working with the worried well, and we really need them working with the very sick.

L. Reid: I appreciate the comments that the hon. minister has made. My purpose in asking the question was whether or not we believe there has been some ability to somehow coordinate the services between the practitioners and other providers in the area of mental health. There aren't sufficient psychiatrists at this point; we accept that notion. Your point is that there are folks other than psychiatrists who currently provide service. I'm not taking issue with any of that. I simply want to know what kind of integration and coordination has gone on in terms of bringing those two groups closer together. Quite honestly, it seems -- probably to legislators in this House and also to members of the community at large who happen to have someone in their home, in their family, who is mentally ill -- that community services are in no way working in concert with the psychiatrists and the psychiatrists' evaluations of their family members.

Hon. E. Cull: I agree with the member that the services in the past have been inadequate. They have been fragmented and not well coordinated. For that reason, we are making changes this year in the delivery of services. We are providing a local focus for the coordination of mental health services, so that we are pulling together the psychiatrists with the mental health care providers in the community and, most importantly, with the community groups that have been working and lobbying so long to have this changed.

I can give you one example. It's one that's very close to home for me. It's in Victoria, where there is a coalition of mental health providers being pulled together so that there is full integration and no gaps in the service, and so that we have an idea of the priorities for expanding and extending service.

L. Reid: The minister was making the point that when these folks leave where they are currently located -- perhaps Riverview -- they are going to be moving into hospitals. Are we looking at adding any additional funding to hospitals in this province to accommodate the mental health patients who may arrive in their community? It may be that they don't stay long in the hospital facility in the community. They may be in transition on their way to some community service or community support. However, what kind of funding base is in place to accommodate their short or extended stay in hospital?

Hon. E. Cull: We are transferring 175 beds from Riverview into the acute care facilities.

L. Reid: For my clarification, when she talks about putting former Riverview patients into hospitals, is she planning to open new beds in the hospitals and add funding for the support service -- i.e., the psychiatric service that will be required if we're going to increase the mental health population? Let's use the Richmond hospital as an example. If we're going to put people from Riverview in Richmond General -- and they may stop there in terms of finding a more appropriate place in the community -- is any additional funding being put in place?

Hon. E. Cull: The member is misunderstanding what is going on. Patients from Riverview will be moved into their communities, but we also want to move the capacity of Riverview to deal with emergency and very serious psychiatric situations into communities, because we don't want patients in that situation to have to travel to Riverview either. So there will be both an acute-care and a community care component to our notion of how mental health will be provided in communities.

L. Reid: I appreciate that that's the notion, but I think the minister can appreciate that mental illness is a fluctuating disease. Someone who leaves Riverview may not be in the same mental state a month later or a year later. At that point they're in the community. What kinds of things are in place? My comment to you earlier, hon. minister, is that they may indeed reside in our local hospital -- again, if we're using Richmond as an example -- at some point. I don't think that can be ruled out.

Certainly the research on mental illness has proven strongly that that kind of illness is constantly in flux. What kinds of safety nets do we have in place? Currently in the riding of Richmond -- and I can speak very intimately about this information -- we have suggested that there are community services available. We

[ Page 3269 ]

can make the case on paper that they're available, but we cannot suggest to anyone in this House or to British Columbians at large that every single person who needs a service provided to them once they leave Riverview actually receives that service. That's not the case in my riding, and I would not suggest that my riding is unique. I would suggest that problem is pervasive in the entire province.

Hon. E. Cull: I've said on several occasions that the situation in mental health that has been inherited is one of chronic neglect. I know the member does not expect that in three months, with $53 million, we will have changed the circumstances in her riding. I know she will be patient, as the communities work out how best to provide that money to services in their communities.

The vision we have for mental health is that there will be the continuum of care that is required for the mentally ill in their own communities, including emergency and acute-care services in local hospitals as needed, community residential facilities and also outreach and community support services for those who are on a well part of their cycle. People do go back and forth in terms of their need for mental health services. But if the member is saying her community is still in a mess when it comes to mental health services and why isn't it there, I agree. It probably is in a mess, as is the rest of British Columbia, when it comes to mental health services. We are working on it. We have certainly indicated through this budget that it will no longer be neglected. It's going to take a little bit of time for those services to get up and running and start making a real difference in people's lives.

L. Reid: I think there is some agreement between us that the uncertainty of mental illness coupled with the uncertainty of service delivery is causing some problems. The additional overlay to that, now that Bill 71 has passed second reading.... Certainly the government side of the House never supported the notion that that particular piece of legislation would have any impact at all on attracting and retaining specialists in the field. If that is still your position, I would like to talk about psychiatrists.

The Chair: It's not appropriate to canvass legislation in Committee of Supply.

L. Reid: Again, my question is in terms of integrating the services. We've touched on that. We've touched on the notion of a safety net in the community. All those things make sense. At the end of the day, a lot of this service needs to be guided by a practising professional psychiatrist. What plans does the minister or the ministry have in place to ensure that those individuals are attracted and retained in our communities in this province?

[10:15]

Hon. E. Cull: I'm just checking some of my facts here. Probably overall there is not a shortage of psychiatrists in B.C. We have a problem that we have shortages in some areas, particularly the rural communities in the north. We've talked about how we attract physicians to go to those communities. The other problem that we have is that we have too many psychiatrists in private practice and not enough working directly with the chronically mentally ill, the severely mentally ill in our communities. I think we're going to have to find ways to make the salaried and sessional components of our budget more attractive to psychiatrists so that we can move them in that direction. Again, to use the phrase that I hear all the time from the mental health community, as long as psychiatrists are treating the worried well but not the severely ill, we will have a shortage of people to treat the severely ill.

L. Reid: I appreciate the notion of the worried well that you referred to; however, that is not coming up with a practical solution as to how we get psychiatrists working in the field of the severely ill. You can make the case that they may wish to be involved in another aspect of care delivery. That is fine. That is their choice. They're obviously going to stay in that area, because it's keeping them busy enough to stay in practice.

Given that we need to encourage folks to get into the other aspects of care delivery for the severely ill, how do we do that in practical, pragmatic terms? I mean, we all recognize that there's a difficulty in that. How do we shift some of those folks, or indeed how do we attract new folks interested in delivering that care to the severely ill in our communities?

Hon. E. Cull: We are addressing the problem of the shortage of appropriate, trained medical practitioners in this area through the B.C. Mental Health Advisory Committee. One of the other things we need to do is have a look at medical training for GPs. We need people who are basically generalists, but who have a better idea of some of the specialties. I don't think that we have enough GPs with the knowledge of mental health issues. We have to address the problem, and I suggested that we have a look at the salaried and sessional, because that is the way the majority of these people work when they're working directly in the part of the system that you and I are talking about: the community part of the system, as opposed to the fee-for-service system. It seems to me that we may have to make that area more attractive so that more psychiatrists, particularly young doctors, are attracted to it. I'm quite willing to have a look at making salaried and sessional a lot more attractive.

L. Reid: For my clarification, you were speaking about generalists and perhaps suggesting that they should be involved in speaking to patients about mental illness. Was that the direction you were headed in?

Hon. E. Cull: I would say the vast majority of mental illness is first detected in GPs' offices, particularly when it's at a very early stage. It would be appropriate if those people had better skills in dealing with those problems.

[ Page 3270 ]

L. Reid: I appreciate where you're going with that line of responding, but earlier this evening you said that generalists were not paid to talk to people, and you suggested that somehow they drove all those other costs. If indeed it's now appropriate for them to be talking to people, I think we need to revisit your earlier remarks and suggest that yes, discussion in a doctor's office is completely valid and should be something this health care system looks at funding.

Hon. E. Cull: I agree completely. The only reason that the fee schedule is the way it is is because of the B.C. Medical Association. If I could change the fee schedule around, we'd be paying for doctors to listen to people.

L. Reid: Frankly, that warms my heart, hon. minister, because right now I believe practitioners in this province do listen to people. What you're saying is that it will now be recognized. I think that's good news. I don't think that every time you visit a physician, as you stated earlier, they somehow perform some invasive service. I can't accept that notion. I think there are lots of them who simply listen to their patients to get to the root of the problem.

One of the other issues that has come forward that I want to touch on -- and we've touched on it a little bit -- is the transfer of mentally ill patients to the community. Once these folks are back in the community, it's often going to mean an extra burden for the family. Do we have programs in place? Has the minister undertaken any studies or done any analysis of the impact of deinstitutionalization on the families of those removed from Riverview and other such facilities?

Hon. E. Cull: We are working very closely with the Friends of Schizophrenics, through the partnership program. We've provided additional money this year, as I've already mentioned, to consumer and family involvement, recognizing that.

L. Reid: One of the more significant concerns that I'm sure many MLAs in this House will have shared with members of their constituencies is the lack of respite care. The families with someone who is mentally ill, who is either left in an institution or has been cared for in the community, and whose condition worsens or is in flux, like the mental illness that we spoke of earlier.... When it comes to the point where they truly need a couple weeks off, there doesn't seem to be support in place to look at that. By keeping a lot of those folks with their families, there is a tremendous cost saving to the community at large. What they're asking for in return is one or two weeks of respite care, of uninterrupted time to rejuvenate. Does the minister have any comments on that?

Hon. E. Cull: I agree with the member that respite care is very important, not only for the mentally ill but for other groups that require that kind of intensive care, which can be exhausting to families. For that reason, this year we have put a considerable amount of money into rehabilitation programs and supportive housing, which do have a respite component to them.

L. Reid: I speak again as an educator. I'm interested in knowing if the Ministry of Health has any programs in place to teach families how to recognize the extra stresses placed on them and hopefully how to deal with those extra stresses.

Hon. E. Cull: We're working very closely with the CMHA on developing programs on this. As I said, there is $3.4 million in programming for consumer and family involvement, which would take into consideration some of the things that the member has just mentioned.

L. Reid: Again speaking as an educator, my concern is not just for older mentally ill patients. We are having tremendous difficulty in our school system with very severely emotionally disturbed young people. That's an issue for the Ministry of Social Services, but in my view we're going to need to provide a continuum of service. Oftentimes, hon. minister, people are not cured of mental illness. It is a lifelong learning strategy. Something needs to be brought into place so that they can recognize their difficulties as they arise, learn to identify their specific behavioral traits and hopefully put in place an adequate response. All of that, I believe, is a teaching exercise, but I believe it has to be coupled with Ministry of Health intervention, because a lot of it is going to be medication and training.

Can you give me some comments in terms of what plans we might have in place for the very young emotionally disabled in our communities?

Hon. E. Cull: We have $5 million of additional funding going into mental health services for children, including $1.6 million going directly to schools for psychologist services. I also recommend to the member that she take an opportunity, if she hasn't seen it, to view the Healthy Schools video, which talks about mental health in schools as a very broad concept, which I think is an excellent start for those schools that are participating.

L. Reid: Again speaking as an educator, this is a very serious issue for me, because many of the parents I have dealt with over the years who have had children who have been severely affected have not felt that the service was coordinated. They have not believed that they could go to one central source. I'm sure we're moving into an interministerial direction, and we're going to connect some of these services. But quite honestly, we need to be able to give parents some sense that we have their child's interest at heart and are going forward with the best possible delivery system. Can I submit to you this evening that perhaps it would be appropriate for one ministry to coordinate that? Frankly, I support the notion of interministerial connection, but when it comes to a very, very, young child.... I mean, we have children in our systems who are just one and two years of age who have significant emotional overlay, which is going to lead to some kind of handicap

[ Page 3271 ]

unless some kind of services are put in place. Again, hon. minister, what can you suggest for the parents who are watching this evening and want to know where they can look for support?

Hon. E. Cull: It's a very complex area, and certainly the need to integrate those services and particularly to provide them to children where they are, which is either in schools or even in preschools.... As the member suggests, there can be very young children involved. There are child and youth committees that have been established that are looking at this. We are evaluating how effective they are in terms of providing that integration. But, again, as I say to the member, there has been a lack of integration in the past. There has been a lack of attention to this area in the past, and it's going to take a little bit of time for the ideas that we have in place to actually kick in and start making a difference in the lives of people out there.

L. Reid: I appreciate the direction of your comments, hon. minister. I'm again wondering if there is one central ministry that we can look to, to provide direction to the other three. You and I both support the notion of interministerial committees being the direction. At the end of the day, all that does is frustrate many parents who are seeking appropriate care delivery, because they are told: "I'm sorry, try here. No, try here. No, try there." It's time that we coordinated some of those services, and I would look to you for guidance in this area.

Hon. E. Cull: I know the frustration well of having to go from one agency to another agency of government to get an answer. The simple solution would be to try to put everything in one place. Some people might try to lump it all in the school system; others might suggest Health. I think that what we have to do is to break down those walls between the agencies and between the various programs, and to work harder on integrating them. That's what we're doing. The primary responsibility for delivering the services does rest with the Ministry of Health, but clearly Education has a major role, as does Social Services.

L. Reid: I want to make reference to a specific case. It's regarding the lack of psychiatric emergency services available at St. Mary's Hospital in Sechelt. This particular incident refers to a woman who was brought into the hospital and, after assessment, sent to the RCMP lockup overnight. This is a significant difficulty, and I'm not sure that the weight of this issue is resting on the members of this House tonight. However, I think it's an issue that must be taken seriously by legislators in this province, because at the end of the day, you and I can sit here and have this discussion about what should be available, but in the wee hours of the morning when these folks appear at our hospitals to be admitted by the general resident on duty, who does not.... Your point was well taken earlier when you said they often do not have the necessary skills. I understand that. However, I think you and I understanding it is so far removed from how we're going to improve the service delivery in these communities that we need a response this evening in terms of more than an acknowledgement that these situations exist. Where do we go from here?

Hon. E. Cull: I'm familiar with the specific case that the member raises, and I have had staff talk to the hospital about providing an appropriate secure facility for people brought in in the condition of that particular individual. The hospital did an assessment and decided that they could not provide a safe place for that person in their current facility -- safe for herself and for the staff working there. The last ferry, I understand, had already left for Vancouver. They did not decide to call in an air ambulance to take her to Vancouver. The decision was made by her doctor to discharge her -- to the drunk tank, I suppose. That was perhaps not the best decision. The hospital has been talked to by ministry staff since then. I think they are looking at a way of providing a secure facility for future cases.

[10:30]

L. Reid: I appreciate the minister's knowledge of this particular case. If I can just broaden the base a bit here in terms of.... We can perhaps rectify the situation ongoing at the Sechelt hospital, which does not have a resident psychiatrist. It is a 38-bed acute-care facility. All of those things are absolutely prudent to this case. Again, I make the case that this is not unique to this region of the province. Not to move to the letters that we have that suggest that this happens repeatedly -- probably once or twice a week -- in many communities in this province, how do we best rectify the overall service delivery of mental health service to patients who appear at their hospital? I think the minister will appreciate that for many communities in this province, the hospital is the only facility they have.

Hon. E. Cull: That's precisely why we're making the shift from acute care into more community-based care. I think that many of the smaller hospitals and smaller communities around British Columbia would benefit from having more attention given to detox centres, mental health counselling services and supportive housing. If we could start shifting some of the money from dealing with people when they're at the end of the system and they're in crisis, into the front end of the system, and do some intervention and prevention, then we will go a long way to meeting the concerns that the member has raised.

D. Symons: I also have some questions dealing with mental health. It seems to be a problem in Richmond, as you may gather from the questions of the member for Richmond East. During the election campaign the Mental Health Association in Richmond invited all the candidates to a meeting to discuss the mental health problems in Richmond.

Very soon after I was elected, I was invited to come and meet the stakeholders in that community to be shown the problems and to discuss what they've got going for them. They took me out to a group home. I got the impression from an answer that you had given before that the previous administration had done

[ Page 3272 ]

nothing for the people that were being put out of Riverview as they were downsizing. This group home would have had to be in place before your government had taken over. It was marvellous to see this group of women being housed in a community home, being given, I think, the closest thing to a family situation outside of their own home. It was really nice. I will admit most readily that there certainly were not many of these facilities for the needs. In that sense, the previous administration did not provide for the numbers of people they were putting out. A good many ended up without the facilities that these lucky ladies were to see.

I might take a moment or two to give you a flavour of the particular problem I've had come to me, because it involves one of my constituents -- a young man in his twenties who is schizophrenic -- and his family. It's primarily the father who is coming to me with this problem. Over a period of years he has seen his son go further into this, fighting the fact that he is ill, refusing to take his medicine, going on other illicit drugs and basically showing anti-social behaviour. The father knows that the way the son is going, basically he's going to kill himself, or possibly on the way -- as we saw a few things happen in the paper a while ago -- he might kill somebody else in one of his fits of rage. He's fighting this illness that he has.

The father's concern is that there seems to be nowhere that he can turn for help in dealing with his son. His son refuses to take his medicine and refuses to go into care. I guess his son just hates what's happening to him. The father is watching this and seeing his son, whom he loves, go down the tube. There seems to be no help for the son. You mentioned something earlier, and I hope that I caught it right: there will be some help through Friends of Schizophrenics for the family.

There are two problems here: where the son is going and what seeing this happen is doing to the family. He is frustrated -- and this is why he's constantly back to me -- by the fact that he's seeing this happen to his own flesh and blood, and he seems to have nowhere to turn for help. Can you offer some help to this gentleman and to people throughout the province who are in the situation of seeing their own kin go this way?

Hon. E. Cull: We're reviewing the Mental Health Act in conjunction with a review that is now being done on the guardianship act. The problem that the member has identified is a dichotomy between wanting people to have independence and make their own decisions, and not having them be put under guardianship or be told what to do, particularly if they haven't been committed for psychiatric purposes.

Regarding the real concerns, which I understand all too well, that parents and families have about their family members when they are ill and their illness is preventing them from making decisions in their own best interest, we have recently released a paper on amendments to the Mental Health Act that poses some questions around this area. You might find it very interesting to have a look at that. It is a dilemma, and there's no easy answer.

There have been some suggestions made about how we might approach that, but we're still very much in the consultative phase. One school of thought says that people should be able to make independent decisions even if they're not in their best interest, as long as they are deemed to be capable of making those decisions. There is another which says that we really have to look after these people in their own interest and for their own good. That will have to be resolved through some pretty broad community discussion in the months ahead.

D. Symons: I thank the minister for that answer. That is indeed the situation in which this parent finds himself and the young man involved. The father seems to be asking whether there isn't some place where -- I don't like to use the word "incarcerate," but that's basically what he wants done -- the son can be under the control of someone so that he can get his health back and get onto a regime of taking medicine. I would appreciate it if you could give me a copy of that. I would like to share it with the gentleman and say that at least they're looking into the situation, and there might be some hope for him in future. I thank the minister for that.

L. Reid: I want to refer to the case I cited earlier regarding the situation at St. Mary's Hospital in Sechelt. When we look at deinstitutionalization and putting these folks into the community, I think we both agreed earlier that oftentimes those services are simply not going to be available, which is exactly the situation that transpired in Sechelt. To somehow suggest that a hospital with a 38-bed acute-care situation was not able to accommodate this particular individual.... I'm not convinced, hon. minister, that this particular individual is unique in any way; in fact, I'm convinced that this particular scenario plays itself out in many communities on many days in any given week.

Having committed that to the record, what I'm asking is.... My view on all of this is that there will be an increased burden on the community, that these community care programs are not going to be able to take on responsibility for an individual such as this because the hospital can't handle it. What happens in the wee hours of the morning for community caregivers? To be completely honest, hon. minister -- and I support the notion that it will be an extended time line -- we don't have community caregivers in place in Richmond, let alone Sechelt. That is no slight to smaller communities around this province. It's simply that if there's difficulty procuring those types of services in the larger communities and municipalities that have incredible proximity to larger hospitals, to Riverview and to those other services, how do we convince caregivers in those communities that they can provide that service? How do we put them in place, and how do we ensure their safety while they're providing those services?

Hon. E. Cull: The Sechelt situation is one where a person was in an emergency that night. She was suicidal and intoxicated. It wouldn't matter where that

[ Page 3273 ]

person was, whether there was deinstitutionalization or not. We are not going to be flying people who are in emergency need all over the province into Riverview to be dealt with. They have to be dealt with in their own community within the capacity of their community. Unfortunately, if they're living in a small community, they are not going to have access to the full range of high-level emergency psychiatric services.

Having said that, though, I think we can improve on those services, and I would not want the member to think for a moment that we're expecting community services to deal with emergency or acute-care needs. There is still going to be a need for acute care and emergency care, and it will be provided as it has always been provided -- through hospitals. We will endeavour to improve upon those services according to the needs of the community.

L. Reid: I appreciate the direction that the minister is headed in, because that was exactly my point: that we cannot ask every single community in this province to provide the services that are not currently available at our hospitals. That simply does not close the loop, in terms of logic. My point in all of this is that if a hospital is not in any position to do it, we have communities around this province that don't have an RCMP lockup. We are putting caregivers at peril, because their security is going to be in question. That is my comment. I appreciate that we're heading in the right direction, but how do we solve the problem today?

Interjection.

L. Reid: Thank you for appreciating the comment, but my question has to receive some kind of recognition that we're going to do something for these communities. To suggest that there's a problem -- yes, I'm aware there's a problem. The people who write these letters to me, as the official opposition Health critic, are aware that there's a problem. I'll ask the minister to think of the wee hours of the morning when one of these people is going to come forward, maybe in exactly the same situation as the Sechelt scenario. They're going to be suicidal; they may be inebriated. This is not unique. What is your response in terms of how that would be handled in smaller communities in B.C.?

Hon. E. Cull: I thought I just explained that there will always be a need for acute-care emergency services in communities, that I recognize there is room to improve them and that we're working with hospitals to improve those services.

L. Reid: Yes, hon. minister, you did explain. You did suggest that there would always be a need for acute-care services in this province. We're not disputing the need. We're suggesting that in this case those services were not adequate, were not valid. To suggest that they're there when they didn't solve the problem, did not even appreciate the magnitude of the problem and shunted the person into the RCMP lockup, is an issue.

I have no difficulty with you explaining that acute care cannot be removed from the psychiatric wellness model for the mentally ill. I believe you have recognized that this is not the answer, so what are you going to say, hon. minister, to the individuals who have to treat these folks, knowing that their hospitals are not in any position to take on that kind of responsibility?

The Chair: Does vote 48 pass?

L. Reid: My question is to the minister. Because this issue is very serious for me....

Interjections.

The Chair: Order, hon. members.

L. Reid: I have not yet this evening been satisfied with the level of response I've received or the sincerity with which this House has taken the issue of mentally ill patients in our communities. This is an issue for British Columbians and, frankly, for taxpayers in this province who are very concerned about where we're going to go with the dollars we've allocated.

Yes, absolutely, hon. minister. I appreciate that you have now allocated dollars and that somehow over the next eight years, four years, two years -- whatever it happens to be -- those programs are going to be up and running. Again, my question has to be: what do those programs look like? Please don't explain again that we have acute-care hospitals in this province. I am completely aware of that; the people who write these letters are completely aware of that. There needs to be a specific response to mental illness in this province. Again, you have not addressed that, and I would ask you to do so now.

Hon. E. Cull: I'm not sure whether the member is having some difficulty in hearing the answers because of the noise level in the House, but I didn't simply say that there are acute-care facilities and we will continue to need them. I said that I recognize that the acute-care facilities and the acute-care capacity we have for psychiatric emergency services are not adequate in all parts of British Columbia and that we are working now with hospitals to ensure that we improve upon those services. I think we agree that there is an inadequacy. I think we agree that there's a need to improve upon them, and I think that I've said at least four times that we are working to improve upon them.

L. Reid: Obviously we're not making any headway on the notion of where we should be going in the delivery of mental health services, so perhaps we can be more specific. Let's take the Sechelt situation as an example, because it's salient and because the minister seems to have some knowledge of that situation. If indeed we are going to move to community service in mental health delivery in that community, how many dollars will be allocated to providing that service in Sechelt? How many rooms will we have in the community? Give me some specific information, and then maybe we can go from there.

[ Page 3274 ]

Hon. E. Cull: I will be glad to get back to the member with the specific funding. I don't have it tonight for Sechelt.

L. Reid: I will continue and will trust that hopefully we can have it before the House rises this evening.

One of the most interesting comments that I do not believe has been addressed by this minister in any great detail this evening....

Interjections.

The Chair: Order, hon. members.

[10:45]

L. Reid: Let me tell you, the people who write and phone daily have sincere concerns about this. I would hate to think that they could not receive an answer to their concerns because of individuals who are not taking this issue seriously in the House this evening.

We're looking at what we currently have and the minister has agreed that there are inadequate services in our hospitals for mental health patients. She has also stated that we are going to be moving those services into the community. I have a question in terms of providing for mental health patients if we're not keeping them in the hospital, if they're not suicidal, are not inebriated, do not have to be sent to the drunk tank -- all of those things. If we remove all of that from the equation, we've decided that the person can be maintained, can be accommodated within the community. That suggests to me if indeed the caregivers who provide that service.... Will they be under the BCGEU, and how do we look at responsibility?

I understand completely. I've moved around this province any number of directions in the last number of months in terms of how the public health service, how the public health folks in a variety of areas of the province.... Let's take Prince George as an example, because that was my most recent stop. They have someone who has now been charged with the responsibility of providing community care. They are still not clear as to what that's going to look like, and the minister's response to that -- no matter where the minister speaks in the province -- is that it is going to be decided by each region, for each region, unique to each region. I have no difficulty with that, but there are going to be some commonalities, some frameworks, some discussion points that perhaps the minister can share with us this evening.

Hon. E. Cull: I think the member asked a question about the unions somewhere in there. They will be BCGEU, BCNU or LPNA. She asked what the commonalities would be. The commonalities will be the continuum of care and the community control over the planning and delivery of those services.

L. Reid: I appreciate the response. My question in addition to that looks at whether or not these new jobs in the community, which will be BCGEU, BCNU or HEU, will be in addition to the jobs that are currently in place in our institutions.

Hon. E. Cull: Yes.

L. Reid: I would very much be interested in the number of jobs that are going to transfer into the community. That was where we started, and that is where I would like to end this evening.

Hon. E. Cull: I regret to say that throughout the course of this discussion, it seems the member has sort of lost track of the shift that we're talking about. We're not talking about a shift of psychiatric services in communities from acute to community. We're talking about a shift from Riverview to communities. We're talking about providing more community-based services. There will not be any shift of psychiatric services out of acute care. Where we already need those services out in the community, there will be additional staff placed into community and mental health.

L. Reid: We do not disagree. We cannot shift services out of acute care into the community, because they currently do not exist in acute care. On that, you and I do not disagree. My question was and still remains: what is the number of individuals who will be overlaid into a community -- not taken out of acute care and magically transformed in the community? What additional staff will be in place in communities? If we need an example, let's take Sechelt.

Hon. E. Cull: There will be 248 new FTEs in mental health this year going into the community sector.

L. Reid: Can the minister confirm that a consultant has been hired by her ministry to do a thorough review of ministry operations?

Hon. E. Cull: Yes, and the answer is no.

L. Reid: The hour is late, and the minister suggests that I have somehow lost track of where this discussion is going. What I would like her to do in the few minutes remaining in the debate this evening is to suggest....

Interjections.

The Chair: Would the House come to order. It's awfully difficult to hear the debate as it proceeds.

L. Reid: I appreciate the comment, because I'm not sure at this point if the minister has answered the question or if it's simply the background noise.

Let's work on this one again. Has a consultant been hired? If so, give us the details.

Hon. E. Cull: The member asked me if I could confirm whether a consultant has been hired. I said: "Yes, I can confirm, and the answer is no."

L. Reid: If I might ask a number of questions this evening in the area of hospital funding.... I've listened very carefully to the debate, and I suggest that a lot of this is going to be new information. I would expect us to

[ Page 3275 ]

engage in some kind of meaningful dialogue, so that this does not continue to become the mockery that some members are suggesting it is.

I need to know -- and certainly constituents in this province need to know -- if the minister is contemplating any change in the funding formula for health facilities over the next year. The minister has broken out hospital funding, but if we're going to move to a model of community care, will those facilities -- the minister has mentioned many times this evening that we will be constructing and perhaps revamping new facilities to accommodate our changing needs -- in addition to hospitals have a specific funding formula?

Hon. E. Cull: Our funding formulas right now are based almost entirely on demographics. We are trying to amend that and improve upon it. We will be making refinements this year, both to hospital funding and to funding for community-based programs, which are also demographically determined.

L. Reid: As I and a number of my colleagues this evening have already mentioned, the current funding formula penalizes northern facilities. They often cannot work as efficiently as those in urban areas. I don't think we have any disagreement with the basic notion that the volume of patients moving through facilities sometimes determines its economy of scale. If we remove that from the equation.... Let's take a northern hospital, for example. It may have a longer average-per-patient stay. That is an issue, because we are now looking at the feasibility of discharging someone from a Vancouver hospital and their returning to Richmond. It's a vastly different issue. My colleagues from the north have touched on this in a lot of detail; however, I think there are questions that can still be asked on this. To my mind, the fact that these patients stay in hospital suggests a high degree of caution and care on behalf of their institution and the physician who is charged with their care. Are we giving any kind of funding consideration to the fact that that is the reality in northern communities? Could you respond to that?

Hon. E. Cull: We went over this item at length earlier in the estimates. I explained at that point that the consideration we've given to northern hospitals is to give them 50 percent above the average cushion to deal with their particular needs.

L. Reid: I appreciate the response. However, my question was larger than that; it was broader in scope. It was not looking directly at hospitals. I was really clear when I directed the question to you at the outset. You had mentioned earlier this evening that you will be increasing the number of facilities and perhaps varying the style of delivery of services that those facilities will operate under. In fact, you also mentioned that a number of those facilities are not yet built. Is there a different funding situation or funding premise in place, not for hospitals but for community care facilities?

Hon. E. Cull: I think the member is assuming that community health care is delivered through facilities that we would be building. Community health care will be delivered through programs, and there will be a variety of locations for those programs. Some of them are in place; some of them will be through the public health units which already exist. As well as for hospitals, we have a planning program for continuing care and for public health in terms of capital programs. They are based on population, on demographics and on the needs in the community, and there are funding formulas applicable to each. I'm not sure whether we're talking about capital or operating, but if we're talking about capital, it's all based on population and demographics.

L. Reid: We're talking specifically about community care facilities. Yes, they do exist, and the minister has mentioned them many times during discussion this evening. A lot of communities around this province do not currently have even a clearinghouse from which public health nurses and speech and language clinicians will work. We have touched on this in the past; however, to my mind the question has not been answered. We have community care facilities being put into regions of this province. It is being speculated that they will be offered from regions of the province which do not currently have a single community building, if you will, other than the hospital. You're suggesting that somehow the move will be to deinstitutionalize. My question to you is: where will those services be offered from? I appreciate that they are going to be offered in someone's home in the ideal world. But at the beginning of any program, there will be some place that those services are going to be coordinated from. That is the question.

Hon. E. Cull: Health care services are located in hospitals. When the member talked about community facilities, I thought at first she was talking about community care facilities -- long-term-care facilities. I don't believe she is, but that's another place that health care is delivered where there are actually buildings. There are public health units throughout the province. I believe there are 25 expansions, and new ones are being proposed this year. It is also provided in mental health centres throughout the province. In addition to that, a lot of the community programming is being provided through community agencies, and their funding includes accommodation, whether it is rented space, built space or what have you. If you're asking about the buildings, there are a lot of places that those services are provided.

L. Reid: We're getting closer to the question. Yes, I fully support the notion that those services are provided in a variety of settings. We touched on that earlier, and we've been over it two or three times. The question is again, hon. minister: is a different funding formula in place for these services that will be provided, as you stated, in facilities other than hospitals, or is the funding formula the same as it currently stands for hospitals?

[ Page 3276 ]

Hon. E. Cull: The funding formula for all facilities is based on needs and demographics, so I think what we're doing.... When you talk about the funding formula that we talked about the other night for the hospitals, that was the operating funding formula. There isn't a funding formula for capital. We just have a look at where the needs are and try to provide facilities to meet the population needs. We're looking at population and demographics. There isn't a formula per se.

L. Reid: If the minister is taking issue with the term "formula," obviously that's a bit of a problem. Let's just call it how we spend money in communities based on whether or not we need a new facility. What drives the decision that determines whether we build a new facility?

Hon. E. Cull: Needs and demographics.

L. Reid: To be really simplistic, how much need would have to be demonstrated in a community -- let's take Sechelt as an example -- to have your ministry decide that it is an appropriate place to house a new building for the delivery of community care services -- i.e., closer to home, so there is no confusion?

Hon. E. Cull: The need is assessed. The requirements for staff and space are assessed. The space already existing in the community is assessed. If there is need for additional space, it's provided within a five-year capital budget program. Many of those services, though, will be provided through operating grants to community agencies and will not be part of the capital budgeting process.

[11:00]

L. Reid: I understand that Burnaby long-term care has been in touch with the Health ministry to discuss initiating an investigation into the management of funds and the quality of patient care at St. Michael's Centre in Burnaby. Many of the allegations of irregularities at St. Michael's are serious. Because it is partly funded by the province, mismanagement of funds should be an urgent issue for this ministry. Can the minister tell us the status of this investigation? Who will be conducting the investigation -- Burnaby long-term care or the Ministry of Health? What is the time line? What will this minister be looking into?

Hon. E. Cull: I'd be happy to get back to the member with the details on that question. I'll send her something in writing on it.

L. Reid: One of the points I wanted to discuss in some detail this evening is the current situation we have in the province in the selection of hospital boards. As you may be aware, the Liberal opposition has strongly supported freely elected hospital boards, not the single-issue dilemmas we find rampant throughout this province. Certainly my riding of Richmond East has been a strong contender in the field for the most bizarre health care operation. We are looking at whether or not the minister would consider it feasible to have hospital boards elected in free public elections -- i.e., at the same time as school trustees are elected in this province. The underlying principle has to be that no one in this province should be disfranchised because of having to belong to a hospital society and having to pay their $10. We do not support that notion. We're wondering what direction the minister is headed in.

Hon. E. Cull: I agree with the member that having to pay to elect a member of a hospital board is contrary to any kind of democratic notion. We are having a look at the recommendations of the royal commission with respect to elected hospital boards, in the context of the bigger picture of governance of health care. We have not made a decision yet as to whether there should be something more like regional health councils which should be directly elected; the concept of hospital boards, union boards of health and regional hospital districts may need to be rethought to fit into that. It's a question that's being looked at under our review of the royal commission recommendations.

L. Reid: I have no difficulty with the comments you have made. I would submit to you that perhaps this would be a reasonable subject to refer to the Select Standing Committee on Health and Social Services to explore whether or not this province moves to freely elected hospital boards.

D. Symons: Seeing the hour, and also noting that some of the members' attention seems to be wandering at this late hour, I would move that the committee rise and report progress.

Motion negatived.

L. Reid: Certainly the minister has suggested that she has some sentiment for the direction that we would like to head in: freely elected hospital boards. I'd like to explore that in great detail this evening, because quite honestly, I think that the way we go in terms of the governance of health care is a bigger issue and perhaps needs to be addressed outside of this forum.

However, I'm not convinced, hon. minister, that we can continue to look at the issue of governance separately and distinctly. So my comment about referring it to the Select Standing Committee on Health and Social Services was germane to this point because, quite honestly, I think -- and you yourself have suggested many times this evening and over the preceding days -- that all of these issues are unique in communities, that somehow all of these issues need to be addressed from the ground up in the communities they find themselves in. I don't take any issue with that; I think that's really important. So my comment would be: do you favour the Seaton royal commission at this stage? It does not, I believe, stand firmly behind freely elected hospital boards.

Hon. E. Cull: I said that we are looking at the recommendations of the royal commission. It raised a number of points, particularly with respect to tertiary-care facilities -- what is the community, and how

[ Page 3277 ]

would you go about electing it? However, I referred the entire matter to the review of the royal commission to be taken into consideration with the larger question of governance and regional health councils.

L. Reid: I appreciate the minister's comments, and I trust that we will explore that question in tremendous detail over the next number of hours that we sit tonight. I know we will be revisiting it as we go.

I would like to turn in the next few moments to an intense discussion of the Medical Services Commission, looking at fee-for-service payments. Could the minister please inform the House what the actual expenditure for the Medical Services Commission for physicians' services was in 1991-92?

Hon. E. Cull: I believe we're dealing with the '92-93 budget tonight, are we not?

L. Reid: Hopefully the minister's inability to answer the question will not impinge on further answers that we can look to for some validity. The answer to the question, hon. minister, is $1.24 billion. That being the case, hon. minister, we are looking at a current budget for '92-93 of $1.27 billion.

Interjections.

L. Reid: If you would like to rise, I will absolutely hear from you.

The dollars that we currently have allocated for physicians in '92-93....

Hon. E. Cull: The $1.271 billion that the member refers to is only the physicians' portion of the Medical Services Plan, not the entire Medical Services Plan. The amount the member cited as being spent on the Medical Services Plan last year was the entire plan, including complementary practitioners.

L. Reid: To the minister, I believe she and I are still working on the same answer here. If it is $1.27 billion -- and I believe it is -- for 1992-93, the dollars allocated for physicians in 1992-93 is really a 2.58 percent increase in budget expenditures and is not the 4.3 percent, as we heard earlier. Could the minister please comment?

Hon. E. Cull: Last year the doctors' portion, which was not separately broken out, was $1.213 billion; this year it is $1.271 billion. That's a 4.7 percent increase.

L. Reid: The minister has just stated that it is a 4.7 percent increase. The hon. member for Prince George-Mount Robson earlier this week suggested that it was 4.3 percent. Which minister of the Crown is correct? Where do we go from here for receiving information that is absolutely in conflict? This is not reassuring me that this minister has a handle on her Ministry of Health.

Hon. E. Cull: I would suggest, Mr. Chair, that if the member has questions about the Health budget, she direct them to the Minister of Health and not to other ministers.

L. Reid: Since you rose, I can only assume that you are the Minister of Health. So if you would kindly answer the question, I would be most appreciative.

Hon. E. Cull: I was referring to the member saying that she had asked another minister of the Crown what the budget was and got a different number. I'm sure if you ask me what the budget for the Ministry of Forests was, I might not get the number correct either.

The amount is $1.271 billion this year, and it's 4.7 percent over expenditures last year.

L. Reid: I did not ask the other minister; the other minister volunteered that information in debate in this House. The Blues, I believe, hon. minister, will come forward.... Again, obviously ministers of the Crown should have some integration of thinking and the same information. I would wait for the minister to respond to the question. Two ministers with two different views. There has to be some reasonable process in this province so that the taxpayers who fund the system can believe they're getting reasonable information. I am not assured of that this evening.

The hon. minister should be so kind as to inform this House what the projected population increase for British Columbia will be in '92-93, because she has made reference many times in the Health estimates debate to how that will be a factor in how many dollars are allocated for health care in this province.

Hon. E. Cull: It's 2.4 percent.

L. Reid: Can the minister please tell this House if any funds are being added to provide an increase in the fees paid to physicians or other practitioners to reflect this increase?

Hon. E. Cull: The 4.7 percent in the Medical Services Plan budget that applies to physicians includes 2.4 percent for population growth, 2 percent for inflation and 0.3 percent on top of that.

L. Reid: Again, if we can have some detail.... We're being a little bit general here this evening. I'm interested to know how that breaks down in terms of population and how it reflects physicians, chiropractors, optometrists, naturopaths. Is that going to be information that we can count on receiving from the minister this evening?

Hon. E. Cull: The $1.271 billion we've been discussing applies only to physicians. There is an additional amount in this year's estimates. I'm sure the member has looked it up in the blue book. It is $1.5 billion this year, which is a 4.89 percent increase over last year. You will see by looking at that and at what I've said about physicians that there is an equal increase for the complementary practitioners.

[ Page 3278 ]

L. Reid: She has suggested that they are complementary practitioners. I don't take issue with that. However, I'd be interested to know what kinds of negotiations are ongoing in terms of indeed increasing the number of individuals who are currently under the plan. I know a number of individuals have made contact with your office about being considered under the plan.

Hon. E. Cull: Is the member talking about acupuncturists, midwives? Are those the types of groups you're talking about being considered under the plan?

L. Reid: If the minister wishes to start with those, that would be fine.

Hon. E. Cull: The first group has an application before the Health Professions Council, and the second group, I hope, will very soon have an application before that council to become a licensed self-regulating body in this province. Until the Health Professions Council has dealt with their application, they will not be a licensed body.

L. Reid: I know that earlier we touched on psychiatrists in the province. Does the discussion this evening touch on registered psychologists in the province? If so, what is the status of their application before your ministry?

Hon. E. Cull: The psychologists are already a licensed profession and already exist. Some of their services are covered through the Ministry of Health, through the family and community health branch. They are not now currently recognized as a service under the Medical Services Plan.

L. Reid: That is my understanding as well. What is the status of them reaching an opportunity where they will be covered by the Medical Services Plan? Is that the next step for your ministry?

Hon. E. Cull: We're constantly reviewing requests to increase benefits under the Medical Services Plan. But I think the member will understand full well that the amount of money we've allocated to the Medical Services Plan this year -- almost a 5 percent increase -- can hardly be stretched any further unless we're to take services away from other practitioners. Her side has already been very eloquent on the need to maintain funding for doctors and not to spread that funding to other practitioners.

D. Symons: I'm wondering if the minister is aware of the use of sleep deprivation as a method of torture. This has used by many countries that Amnesty International has investigated. An investigation in this House might be in order. I'm wondering if the minister could possibly suggest that, in view of that possibility, we might move adjournment of the House, and we can report progress and ask leave to sit again.

The Chair: Hon. member, the motion would be out of order as it has already been negatived.

Hon. E. Cull: I was just going to say that the discussion has been so fascinating, I'm surprised that the member is concerned at all about this.

[11:15]

D. Symons: I was concerned at the lack of interest and the lack of concentration on the discussion by opposite members. I do have a concern about what has been referred to before in another matter as rationing of health services in the province.

If we take Richmond General Hospital, I was contacted by a person quite a few months ago. This person had a mother and was concerned that she needed orthopedic surgery -- a hip replacement operation. Apparently she had been told by the doctor, who had been told by the hospital, that she would have to wait till the end of that fiscal year, which was last March 31. This was going to be a three-month wait for her until the operation could be done, because the funding for orthopedic surgery in that hospital had been used up for that fiscal year.

It was very soon after this that I got three more calls of a similar nature. One of them involved an older woman who had burned her hand severely on the stove. She was so drugged up to cover the pain from her hip that needed replacing that she didn't know she burned her hand when she put it on the stove. The problem here is that these people were in serious pain, and they were told.... I'm glad these members are commiserating with this difficulty here.

An Hon. Member: We're in serious pain here.

D. Symons: I offered to put it to an end.

The Chair: Would the House come to order, please.

D. Symons: My concern here is that I checked with the hospital and found out that this was the case. Indeed, the doctors had been told that they had to stretch out the orthopedic portion of their budget for that full year. These people would have to wait. It seems to me that if you have people wait three months, somewhere down the line, as it goes on and on, it's going to be a six-or nine-month wait each year when you add more and more people to these wait-lists. Is this really the way in which health care is going to be delivered in this province? Is this the way the hospitals are going to be required to deliver health care? It's obviously being rationed.

Hon. E. Cull: Mr. Chair, I'd be happy to send a copy of a letter that the chief executive officer of the hospital has written explaining the circumstances around the situation the member raises.

In hospital budgets there is no such thing as a budget for orthopedic or prosthetic devices, which is what he's talking about. Hospitals receive a global budget from the province, and they make decisions. Some hospitals

[ Page 3279 ]

-- I'm not certain if Richmond is one of them -- use their budget for prosthetic devices to limit operating room time for orthopedic surgery. That decision is entirely within the purview of the hospital. They can make a decision about how much money they put into orthopedics versus any other kind of surgery.

L. Reid: If I may return to the line of questioning I initiated with the minister regarding the costs of where we're headed with health care, I suggested that we need to look at the supply of dollars to other health care deliverers: chiropractors, optometrists and naturopaths. That's where we left off. I'm not reassured by this minister when she suggests that somehow there will be dollars available to look at aging in our population.

[M. Lord in the chair.]

Am I to understand from this minister that she has made no provision for either the impact of increases in the cost of living or in practice expenses on physicians in terms of their net incomes? We've all had the discussions many times in this House in terms of overhead, what that looks like and how it impacts on the dollars. Can the minister provide an estimate of how the real net income of physicians will be affected by her failure to take these two factors into account? Again, let's not restrict this discussion to two factors; let's look at population growth and aging. Those are issues that need to be reflected in this budget. This is a budget issue.

Hon. E. Cull: Population growth has been fully covered in the budget, as has inflation. In fact, I believe the current rate of inflation is actually lower now than what we've provided for in the budget. There is a small amount over and above that which can be used to address aging. I would draw the member's attention to the Royal Commission on Health Care and Costs, which suggested that we do not address aging or utilization; that there is enough room in the system to accommodate that.

L. Reid: Certainly you can suggest that the royal commission has looked at room to move for aging and for seniors in our population. Seniors in this population do not support that notion. The Liberal opposition does not support that notion. There are considerations for the impact of aging upon our health care delivery. If you could expand on that in any detail, that would be interesting.

The Chair: Shall vote 48 pass?

L. Reid: I can only assume from the minister's lack of response....

Interjections.

The Chair: Order, members.

A. Warnke: Point of order. Usually the Committee of Supply has been conducted thus far without heckling from the opposition and so forth. I find it very objectionable that now that we are in Committee of Supply on the last estimates.... I think it would be incumbent upon the Chair to remind members that heckling is indeed out of order.

The Chair: That is not a point of order.

L. Reid: We have looked in some detail at whether aging is going to have any impact on the system. I'm not convinced that the notion is somehow not going to be explored under the Seaton royal commission, and that somehow excludes it from consideration by this House. You have always stated that that is a discussion document and a guideline; that it is something that we might consider. Again, there will be an impact on your budget on utilization as a result of aging. Could you give us some guidance as to how you have been dealing with that? I appreciate the answer that the royal commission is floating out there. I need some practical suggestions as to how you, in your Ministry of Health this year, will handle the impact of aging.

Hon. E. Cull: The overall budget for the Ministry of Health, as we've said now at least five times, depending on whether you're looking at hospitals or community health services or whatever, is based on a demographic model. The word "demographics" includes aging.

L. Reid: If the minister could repeat her answer. I'm not sure if I heard it.

Interjections.

The Chair: Could we bring the House to order, please.

L. Reid: Hon. Chair, if I could ask for a repeat of that answer, I'm not clear on what was said.

Hon. E. Cull: I explained that the definition of demographics includes aging.

L. Reid: I'm hearing that somehow this was covered in some kind of demographic equation. Interesting. I would really be more interested in understanding what that equation is and how it comes to bear on the overall situation. I understand the term demographics. Yes, we can debate the content of that particular phrase on into the wee hours. That is not answering the question. If you could perhaps be specific, we may be able to focus this discussion.

Hon. E. Cull: We've been through the explanation of the demographic....

Interjections.

Hon. E. Cull: Hon. Chair, I can't even hear myself think at this point.

[ Page 3280 ]

The Chair: Order, members. I realize it's late in the evening, but we can't hear the minister's reply. Could the House come to order.

Hon. E. Cull: I've explained the concept of funding both for capital and operating costs for health care. It seems that the member is having a little difficulty understanding this, and I'd be quite happy to arrange for a full briefing for her with my staff so that she can understand the details of the funding formula.

L. Reid: What I'm hearing is that the explanation was somehow related to demographics, but it's a little muddied in the translation this evening.

Again, the question to the minister: is she taking any steps to reduce the impact the aging population will have? I understand from your comments that demographics somehow generates the numbers we have, in terms of the number of people in this province who are aging. I have no issue with that, but again, hon. minister, that is not an answer to the question.

Hon. E. Cull: Yes, we are.

L. Reid: The answer to the previous question was: "Yes, somehow we're going to be looking at that." If I can ask the minister to be specific, how indeed will your ministry be looking at the impact of aging on your budget for 1992-1993 -- just to ensure that everybody is absolutely clear on the direction in which we are headed this evening?

Hon. E. Cull: As has already been canvassed extensively, there's been a significant shift of funds to deal with programs for an aging population, including major increases in home care, home nursing and other support services that deal with the seniors population.

L. Reid: I asked for examples. We received one example. One initiative is home care. If the minister could elaborate and be a little more extensive in her response.

Hon. E. Cull: In my opening speech, and in either the first or the second night, we went through this extensively. I listed all the programs that we're providing for seniors, with dollar and percentage amounts.

L. Reid: A lot of where we're headed this evening is looking at the future of a funding formula, whether it be a funding formula in the area of health, whether it be a funding formula in the area of education. Both of those have some life cycle, if you will. At some point they no longer are valid to the issues we wish to address. I would suggest that a number of the answers you've given this evening are no longer valid to where we're headed in terms of moving from institutional care, acute care, intermediate care, to community care. Those answers probably had their day, hon. minister. They are not sufficient to lay to rest the concerns I have, or the concerns that British Columbians have about the future of their medical system.

I'm personally taking this issue very seriously this evening. I think, quite honestly, that we have to recognize, as serious legislators.... Because, indeed, there are a number of individuals still up at this hour watching this debate, and they are absolutely amazed, hon. minister, that this kind of response is all their concerns merit from the Legislature in the province of British Columbia. I'm not impressed myself. In fact, I'm significantly disappointed that somehow you can see humour in the response from the individuals on your side of the House. I would not stand in this House, hon. minister, and suggest somehow that I am proud to be a member of the government that behaves this way. We are talking about issues that are pertinent to individual British Columbians, which are pertinent to taxpayers in this province. This does not warm my heart.

You indeed have not answered the questions, hon. minister. You are somehow suggesting that demographics drives this, demographics drives that. I take no issue with that. I've done my homework on this. I've done the research that suggests that there are reasonable answers to these questions which you could provide. I believe that you as the minister of the Crown have a responsibility to do that. I'm taking this very, very seriously. You are not, in my view, taking this process seriously. I'd be interested in your comments.

Interjections.

The Chair: Order, please.

Hon. E. Cull: Madam Chair, the member seems to be implying that in an almost $6 billion budget there's something like a funding formula that I can describe in a very simplistic way to tell her how the health care budget is built. We have canvassed the way the operating budgets of hospitals are built. We have talked about continuing care facilities and how they are built, and when it comes to the other budgets that are being built in community services, we set priorities. This year we've set priorities in mental health, children and youth at risk and seniors. We've evaluated the needs, and we build budgets in a very complex way. There is no such thing as a simple formula that drives this. It is a very thorough process that staff and communities go through to determine budgets every year.

L. Reid: If indeed there is this complex, intricate process that your ministry staff goes through on an annual basis to ensure that these programs are funded adequately in the province, obviously there's some historical perspective as to the decisions that are currently in place, what has driven those decisions and how those decisions were reached.

I think that is the information that will make this information much more palatable. Right now there is no framework in which to offer it to the public at large. I'd be interested in your comments.

[11:30]

Hon. E. Cull: I was under the impression that the member had been briefed by staff prior to the estimates about the funding and how this had all been put

[ Page 3281 ]

together. I think if she could be more specific, if she wants to hear about one particular area, I'd be happy to answer, but if she wants me to describe the entire process of building the budget for the Ministry of Health, I think that's a bit vague and unspecific and would take us months.

D. Symons: I was wondering if you've heard the old rhyme: "Early to bed, early to rise, makes a Health minister wealthy and wise." I would move that the House rise, report progress and ask leave to sit again.

The Chair: That motion is not in order, hon. member. It's already been negatived by this committee.

L. Reid: In response to the minister's last comment -- the most recent one -- we need to go back to my question which asked for, most sincerely in terms of.... You simply have said: "Give me a specific example. I don't have to somehow provide you with how I fund health care in the province of British Columbia." Frankly, hon. minister, I think that is your responsibility. I think that is the responsibility of any Minister of Health in this province.

However, because it seems to be too big of a package, and somehow unwieldy to someone who should be the Minister of Health in this province, let's take my original comment which was on aging. Give me the historical framework for how you have addressed that aspect of funding in the health care system in this province.

Hon. E. Cull: When we review the various parts of the ministry budget, we evaluate what the impact of aging is likely to be on that part of the budget, and as we make the projections for next year we build that into our projections for what the increased need in service would be.

L. Reid: The minister also made a comment moments ago that if indeed I didn't have the information I wished, I could ask for a briefing. I have been briefed extensively by your staff, and I have found them to be very helpful. I can suggest, hon. minister, that you would do well to take a page from their book. You have stopped me repeatedly in the hallways -- in the corridor outside this Legislature -- and suggested to me that somehow: who was I to expect a briefing from the Ministry of Health officials? Why would I think that I could receive assistance from the bureaucracy in this province to assist me as a Health critic? My response to you was that every single person in this province who pays taxes is entitled to the services that that ministry can provide. My position today has not changed, so again I take issue with you suggesting a briefing. You have done all in your power to ensure that those briefings were not readily available to members of my caucus.

Hon. E. Cull: I think the member should consider what she's just said, because I have not stopped her many times in the hall to talk to her about this. I talked to her one time when she was harassing my staff. However, if the member thinks that she gets briefings for any other reason than the fact that we facilitate it, I don't know how she thinks she gets them.

L. Reid: Hon. minister, I can only assume that the only person who felt harassed in that interchange was you. Your staff were polite, considerate, responsible and responsive to the questions I posed as a legitimate taxpayer in this province and as a legitimate official opposition Health critic. At no time, hon. minister, will I accept your comment that you found my behaviour of a somewhat harassing nature. I'd be interested in your response.

D. Schreck: On a point of order, the topic of debate is the estimates of the Minister of Health. Who spoke to whom about what briefings is totally out of order and irrelevant.

The Chair: Could the member get back onto the estimates which we are debating here in the Committee of Supply. Please continue.

L. Reid: I assume that the Minister of Health appreciates the comments from her colleague from the NDP side of this House, because she was the person who brought forward the discussion on briefings this evening. Direct the comment where it will do the most good, hon. minister.

Again, I have some concerns about how we continue to fund health care in this province. The minister believes somehow it's not her obligation to discuss that in detail this evening. Frankly, I disagree. I would suggest that she can begin now and take us through to dawn, if it is indeed that extensive and will not allow itself to be encapsulated into three or four responses.

Hon. E. Cull: I've explained hospital funding; I've explained community care funding; I've explained continuing-care funding. Pharmacare funding is done exactly the same way. We've explained Medical Services Plan funding. I don't have the blue book in front of me, but I don't think there's anything left to explain.

D. Mitchell: I have a question for the minister on new technology. I understand from what she has said over the last little while in the House that there are rising costs for the delivery of health care services in our province. My understanding is that one of the major components of the cost is the new technology that is used by medical specialists in our health care system. Having recognized that, I think we all know that when medicare was first introduced, it was introduced on a basis of delivering a product to patients throughout the province. That was very different than the product that is being delivered today, almost a generation later. Here we are in 1992, trying to address the health care concerns of the people of British Columbia with this budget that we're being asked to approve -- a very sizeable budget, the largest in the history of the province. At the same time, the issue of new technology is a major factor here. Of course, to address some of the specialized concerns that are now evident among the

[ Page 3282 ]

population at large, we're increasingly called upon to utilize in our hospitals and clinics technology that just a few years ago would never have been heard of. In fact, some of it would seem to be straight out of science-fiction novels, if we could even have imagined it just a few years ago.

I wonder, hon. Chair, if the minister could enlighten us. Where in the budget is there a specific allocation for new technology? I've looked, and I'm not able to pinpoint it. Or is it just covered under the Medical Services Plan, generally speaking? Could the minister tell us where new technology, in particular, is addressed in this budget?

Hon. E. Cull: The vast majority of it is in the hospital budgets, although some of it is provided for in the Medical Services Plan as fee for services for the people who actually perform the services.

D. Mitchell: I'd like to ask a specific question about something that does require new technology. It's the recent advance in the treatment of something that is referred to as port-wine stains. Has the minister addressed the use of recent laser therapy for this condition?

Hon. E. Cull: We had that question.

D. Mitchell: I'm advised that the minister indicated that she couldn't answer the question at this time. Is that right?

Interjection.

D. Mitchell: Okay. If I could, I'd like to go on to another issue, and the minister can tell me whether or not she has addressed the whole issue of research. Earlier this evening I asked a specific question about research. We talked about Lyme disease, and in the context of that the minister indicated that she would get back to me and that some of her staff were working on answers to that. Could I just ask whether the minister's staff has brought forward any answers to that yet?

Interjection.

D. Mitchell: Not yet. Then perhaps I could ask the minister this question. In that context we were talking about the Centre for Disease Control. Can the minister tell us whether there is a specific role or expanded role that has been recommended or that we can be looking forward to for the Centre of Disease Control included in the budget that we're being asked to approve here?

Hon. E. Cull: There is an additional $1 million in funding for the B.C. Centre for Disease Control, but they obviously have a major role to play in some of the immunization programs and the AIDS programs.

D. Mitchell: On the issue of research, and given what the minister has just said, I'd like to refer to a program that the minister introduced not long ago in this session. It was something that all members of the House applauded: the vaccination program for hepatitis B. I know the minister has talked about that during the estimates review process, but can the minister tell us what the vaccination program for hepatitis B will cost? What portion of this budget is going to be devoted to that program?

Hon. E. Cull: The cost is $3.4 million. As the member knows, it's expanding the program to the high-risk populations, starting in the high schools. I've forgotten the grade level where it starts.

D. Mitchell: I take it that the number the minister just quoted is from this year's budget. It will come out of this year's budget. Okay.

On the issue of new technology, the minister said she canvassed the specific example I used earlier. I have one other specific example I'd like to talk about in the area of new technology. It's a new procedure referred to as a laparoscopic cholecystectomy -- I have trouble with some of these, as the minister does. This is a procedure where a patient's gallbladder is removed using a laserscope through tiny abdominal incisions. The minister may be more familiar than I am with how to pronounce the actual term. Apparently for this procedure the hospital stay is shortened by about four days. It saves the taxpayer a considerable sum of money if the hospital stay can be shortened by up to four days using this procedure. The patient can return to full work and other activities shortly after instead of the usual six-to eight-week delay when regular surgery is performed.

I wonder if, under the area of new technology that I was discussing earlier, the minister can tell us whether this money-saving procedure is included in the medical services estimates. If so, how much will be devoted to this kind of surgery?

Hon. E. Cull: The technology is covered under hospitals; the procedure is covered under the medical services budget.

D. Mitchell: I understand what the minister has just indicated, but my question was: is it possible to isolate within the budget, with your officials present, how much would be devoted to this kind of procedure? I'm just looking at this as an example of something that will save money. The minister says it is covered. Can she confirm that it is definitely covered in this budget and that funds will be allocated towards this specific procedure that will save taxpayers' dollars?

Hon. E. Cull: All of the hospital budgets are global budgets, and I can't break out any of that.

D. Mitchell: As the Health critic was, I guess I'm experiencing a bit of frustration with this process, because we are here reviewing the budget for the Ministry of Health and Ministry Responsible for Seniors for the fiscal year 1992-93. We continue to ask questions. We're not asking them as nuisance questions; we're not asking them for any other reason than to find out the answers. The minister is unable to answer

[ Page 3283 ]

questions about her own budget. That's frustrating. We will canvass a few other topics, though. It's a frustrating procedure for us, hon. Chair. We recognize that the minister is new...

Interjections.

The Chair: Order, please, members.

D. Mitchell: ...and that she's only been in this portfolio for a few months, but these questions are being asked of her when she has the full advice of her staff, who are present to advise her. There are questions that there should be answers for. When we seek to ask questions about the formation of the health care budget in this province and about specific aspects of that budget and the minister comes to this parliament seeking approval for the supply that is being granted to her as a minister of the Crown, then we would expect, as representatives of the people and as legislators in the Committee of Supply, her to answer those questions before we would grant her supply. That's what this process is all about.

Something seems to have been forgotten here. We're only here to ask legitimate questions with respect to her budget, yet we don't seem to be able to get the answers. Of course, we cannot compel the minister to answer the questions. We understand that. It's interesting to note that it doesn't matter what variety of questions we ask; we can't seem to get answers. It's a frustrating process. We will bear with the minister and she will have to bear with us as well as we work our way through this process, as frustrating as it might be for both of us.

I have a question to the minister in the area of health promotion and education. It will be of concern to many members of this House, because many members have been educators in their previous incarnations. Many of us will be concerned about how we promote health. The minister has talked about promoting a system of community-based health care, based on a wellness model which is geared towards a better understanding of health care. One way to achieve that is through modern communication techniques and education in the broadest sense of the word, not only through our school system but also through public education as well. We know that some good work has been done in the schools, for instance, with school nurses. We know the good work that nurses do for our children in our schools. I wonder if the minister can enlighten us this evening as to how school nurses fit into the government's health promotion plans.

[11:45]

Hon. E. Cull: The school nurses are an integral part of that. They work on a wide variety of health promotion activities -- dental health, nutrition, healthy sexual behaviour -- and also, through the Healthy Schools project, demonstrate healthy lifestyles and do health promotion.

D. Mitchell: What the minister has said, I'm sure, is correct; it's self-evident. Could the minister identify whether or not within the context of this budget there is specifically a health promotion plan that's going to be used within our school system? Does the minister plan to use the school system extensively in that health promotion plan, if one exists?

Hon. E. Cull: The Healthy Schools budget, which incorporates the things that I've talked about, is $275,000.

D. Mitchell: Could the minister tell us how the health promotion plan is going to work and how that money is going to be allocated in our school system? What is that money specifically going to be spent on? What will it achieve, given the need for health education and promotion in our province?

Hon. E. Cull: Maybe I can save a little bit of time on future questions here. The Healthy Schools budget of $275,000 deals with the education materials that the member has suggested should be in place. In schools, there's a healthy public policy and knowledge development budget, which deals with a broader community, of $426,000; there's a population health budget, which deals with getting the baseline data that's needed to do population health, of $220,000; healthy workplaces, $464,000; tobacco use reduction strategy, $254,000; healthy communities, $1.295 million; wellness in the health promotion budget, $1.5 million; seniors' health promotion budget, $281,000.

D. Mitchell: Thanks to the minister for the breakdown on the health promotion budget that she's indicated is part of her ministry budget that we're approving. With respect to these funds that are being spent on health promotion and education in our school system, is there a projected payback period -- to use a business term? I think the minister will know what I'm getting at here. Is there a projected period in which there will be a return to the province of British Columbia by virtue of spending these moneys on health education? Do the staff or the ministry have any estimates with regard to when the health promotion initiatives will bear themselves out in terms of a reduction of demand in the health care system?

Hon. E. Cull: There's a lifetime payback of health promotion.

D. Mitchell: I recognize the minister's answer, which I'll accept at face value. What I was simply seeking was the taxpayers' dollars that are being spent on this initiative, which I personally think is a good initiative, and I applaud it. I'm just wondering, in terms of health care administration within the ministry, whether there is any assessment process for the spending of these moneys and the benefits that will be received and will accrue to the province. Is there any kind of assessment process, in terms of a business plan, for the health promotion plan that will assess that perhaps over the course of coming years more money should be spent in this area as part of a wellness model? That's what I was getting at with my question. I'm looking at the return on investment, so to speak.

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Hon. E. Cull: I'll give one example out of the many, and that's the tobacco reduction program. We can very easily chart, over a period of time, the reduction in the number of people in this province who are smoking. We have some estimates of the costs of health care related to smoking, the number of deaths that are related to smoking, and over a period of time we will be able to monitor the outcomes.

D. Mitchell: I appreciate the answer from the minister on that. I take it from what she's saying that the health promotion activities that are being launched as part of this plan will take some time before there's a payback, obviously, because it takes some time for that kind of investment to generate the kind of modified behaviour that's going to result in better health. Given that, and given the comments that the minister has made previously with respect to cutting back on acute care, I wonder if the minister would comment on whether or not she thinks it's prudent that we're beginning to cut back on acute care in British Columbia -- on the basis that health promotion activities will reduce demand for it -- when health promotion activities will not begin to reduce demand for many years. I'm wondering if she can reconcile that. Is there any contradiction there? We're cutting back on acute care at the same time that we're spending money on.... Is there a balance here? Is there an evaluation process within the ministry as to where it is more prudent to be spending money?

Hon. E. Cull: We've provided a 5.5 percent increase to acute-care budgets, so I don't think that's a cutback. Health promotion is not designed to replace acute-care needs. It's designed to prevent sickness and to improve health in our population over a long period of time. That's one measure. There are a lot of other measures, including preventive health care, and community-based health care is part of this whole continuum.

D. Mitchell: Can the minister tell us, with respect to the health promotion programs in the school system, what kind of liaison is taking place with her colleague the Minister of Education and between the ministries? Is there an interministerial task force looking at coordinating expenditures within the Education ministry? How does the Ministry of Health work on this program in conjunction with another ministry in terms of delivering this in the most cost-effective manner?

Hon. E. Cull: There's very close coordination. The ADMs' committee of social policy is working on coordinating these matters.

D. Mitchell: I wonder if the minister can tell us why, earlier this year, the very innovative wellness centres in the Victoria area were shut down, when they seemed to meet all the criteria she has outlined for effective health promotion?

Hon. E. Cull: Madam Chair, we did canvass that item the other evening.

The Chair: That's correct. That area has been canvassed thoroughly in this committee.

D. Mitchell: I know the issue has been raised, but I'm really referring to it in the context of health promotion, not the wellness centres themselves, which have been shut down. We're talking about effective health promotion and about wellness. We're talking about educating not only young people in our school system, but the general public at large. Just a question on this. Wouldn't the wellness centres in Victoria or anywhere else in the province have met the criteria of effective health promotion?

Hon. E. Cull: Not wanting to repeat the discussion of the other evening, the member should be aware that the wellness approach has been expanded under this budget. The change in terms of program delivery in this region has been from a centre-based program to a service-based program.

L. Reid: Over the past weeks that we've been in discussion regarding the future of health care in this province, we have touched on multicultural health care. We haven't canvassed it in any great detail.

My concern this evening is with the number of new Canadians to my riding specifically. I'm not thinking that Richmond East is unique in any way compared to the rest of the province. These folks who arrive in Canada are going to be availing themselves of community health care services and hospital care services.

To be very specific, we will deal with interpretation services in hospitals. If someone who does not speak English comes into a hospital in this province, do we have any support systems in place to accommodate their specific needs?

Hon. E. Cull: This government is trying to hire more people of ethnic minorities so that we will be able to have more culturally sensitive programs. But as to services provided in hospitals, I remind the member once again that the decisions that hospitals make in that regard are the decisions of hospitals, not the decisions of the ministry.

L. Reid: I'm having difficulty with that premise. If you are the Minister of Health, you are going to be guiding the decisions and direction of health care in this province. You can continue to give back the number-crunching argument, and the argument that that particular segment is not your responsibility. I would beg to differ, hon. minister. If you're going to be committed to new Canadians coming to this country, you're going to have to put in place if not the actual dollars to determine that level of service, at least the guidelines or the parameters to suggest that that is the direction you wish to go in. Is that not your stance on this issue?

Hon. E. Cull: Madam Chair, the other night we covered the other things that we're doing in the ministry. But the member is asking specifically right now whether I'm going to direct hospitals to provide

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programs or to hire particular types of people to deliver programs. I would remind the member that we don't run the hospitals in this province. Unless she's suggesting that the ministry take them over and manage them directly, I'm not in a position to direct which staff they hire or what services they provide.

Hon. G. Clark: Boy, a scintillating debate, hon. members! I know that we could go on and on and hear more, and I'm sure that we will tomorrow. With that, hon. Chair, I move that the committee rise, report astonishing progress and ask leave to sit again.

Motion approved.

The House resumed; the Speaker in the chair.

The committee, having reported progress, was granted leave to sit again.

Hon. G. Clark moved adjournment of the House.

Motion approved.

The House adjourned at 11:56 p.m.

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